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Th? Students' Quiz Scries. 



Materia Medica md Therapeutics. 



A MANUAL FOR STUDENTS AND PRACTITIONERS. 



BY 



L. F. WARNER, M.D., 

Attending Physician, St. Bartholomew's Dispensary, New York. 



SERIES EDITED BY 

BERN B GALLAUDET, M.D., 

Demonstrator of Anatomy, College of Physicians and Surgeons, New York; Visiting 
Surgeom Bellevue Hospital, New York. 

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PREFACE 



This compend is based upon the works of such acknowledged 
authorities as Brunton, Bartholow, Wood, Bruce, Edes, and Biddle, 
and upon the compiler's own notes of the didactic lectures of Pro- 
fessor Peabody of New York. It has been the endeavor of the 
writer to consider particularly those drugs which have recently 
recommended themselves to the notice of therapeutists. 

Intended, as it is, for the use of students, the aim has been to 
omit all elaborate discussion, and to state concisely and completely 
the bare essentials as far as it is possible to glean them from a 
mass of more or less conflicting authority. It is hoped that, 
like its companion works of this series, it may be of use to the 
student, and at times to the practitioner, as a convenient and con- 
cise statement of the most important facts of Materia Medica and 
Therapeutics. 

44 W. 24th St., 
New York, July, 1892. 



i 



CONTENTS 



PAGE 

Imponderable Remedies 17 

Heat 17 

Pharmacological Remedies : Actions and Modes of Administering 

Drugs 19 

Weights and Measures 22 

Classification of Drugs 23 

Antispasmodics : Camphor ; Spiritus ^Etheris Compositus (Hoffman's 
Anodyne) ; Valerian ; Asafoetida ; Moschus (Musk) ; Succinum 
(Amber) ; Humulus (Hops) 23 

Anaesthetics : ^Ether (Ether) ; Chloroform ; Nitrogen Monoxide, or 

Laughing Gas. Local Anaesthesia : Cocaina, or Cucaina (Cocaine) . 27 

Hypnotics (Somnifacients) : Opium ; Cannabis Indica and Canna- 
bis Americana; Chloral (Chloral Hydrate) ; Chloralamid ; Potassii 
Bromidum ; Sodium Bromide ; Ammonium Bromide ; Sulphonal 
or Sulfonal ; Amylene Hydrate ; Paraldehyde ; Urethan ; Hyp- 
none ; Methylal. Belladonna Group : Stramonium ; Hyoscyamus ; 
Duboisia ; Agaricin ; Erythroxylon Coca 31 

Spinants: Excito-Motors : Nux Vomica; Ignatia; Cocculus Indicus 
(Picrotoxin). Depresso-Motors : Physostigma (Calabar Bean) ; 
Curare or Woorara ; Conium ; Gelsemium ; Lobelia ; Tabacum 
(Tobacco) 48 

Nitrite Group : Amyl Nitris (Amyl Nitrite) ; Nitro-glycerin (Glo- 
noin) ; Potassii Nitris (Potassium Nitrite) ; Sodii Nitris (Sodium 
Nitrite) . 57 

Cardiac Stimulants : Ammonia ; Alcohol ; Digitalis ; Strophanthus ; 

Convallaria Majalis ; Sparteine ; Adonidin ; Caffeina (Caffeine) . . 59 

Cardiac Depressants : Antimonium (Antimony) ; Veratrum Vi- 
ride ; Aconitum (Aconite) ; Pulsatilla ; Arnica ; Straphisagria ; 
Acidum Hydrocyanicum (Hydrocyanic Acid) ; Potassium Cya- 
nide •. . . . . 72 

5 



6 CONTENTS. 

PAGE 

Vegetable Acids : Citric Acid ; Tartaric Acid ; Acetic Acid ; Oxalic 

Acid 79 

Astringents : Acidum Tannicum (Tannic Acid) ; Acidum Gallicum 
(Gallic Acid) ; Galla ; Krameria ; Catechu ; Kino ; Hsematoxylon ; 
Geranium; Hamamelis; Quercus Alba. Mineral Astringents: 
Argentum (Silver) ; Cuprum (Copper) ; Zincum (Zinc) ; Plumbum 
(Lead); Alumen (Alum) 80 

Tonics : Ferrum (Iron) ; Manganum (Manganese) ; Acidum Sulphuri- 
cum (Sulphuric Acid) ; Acidum Hydrochloricum (Hydrochloric 
Acid) ; Acidum Nitricum (Nitric Acid) ; Acidum Nitro-hydro- 
chloricum; Acidum Lacticum; Phosphorus - . 91 

Alteratives : Acidum Arseniosum (Arsenious Acid) ; Hydrargyrum 
(Mercury) ; Iodum (Iodine) ; Potassii Iodidum (Iodide of Potas- 
sium) ; Iodoformum (Iodoform) ; Iodolum (Iodol) ; Aristol ; Oleum 
Morrhuse (Cod-liver Oil) ; Acidum Phosphoricum and its Salts. 
The Hypophosphites : Sarsaparilla ; Guaiaci Lignum ; Guaiaci 
Kesina ; Ichthyol ; Colchicum 99 

Antiperiodics : Cinchona; Eucalyptus Ill 

Antipyretics : Acidum Salicylicum (Salicylic Acid) ; Salicinum (Sali- 
cin) ; Oleum Gaultherise ; Salolum (Salol) ; Betol, or Naphtholol ; 
Acidum Carbolicum (Carbolic Acid) ; Sodii Sulpho-carbolas (Sul- 
phocarbolate of Sodium) ; Creasotum (Creasote) ; Creolin, Kreolin ; 
Thymol ; Resorcin ; Benzoinum (Benzoin) ; Acidum Benzoicum 
(Benzoic Acid) ; Antipyrinum (Antipyrin) ; Antifebrin ; Phenace- 
tin; Thallin ; Kairin ; Naphthaline 116 

Stomachic Bitters : Simple Bitters ; Quassia ; Gentiana (Gentian) ; 
Columba (Columbo) ; Chirata ; Hydrastis. Aromatic Bitters : Ser- 
pentaria (Virginia Snakeroot) ; Anthemis (Chamomile) ; Eupa- 
torium; Cascarilla; Cimicifuga. Astringent Bitters: Cornus; 
Prunus Virginiana (Wild Cherry) 128 

Diuretics : Scilla (Squill) ; Scoparius (Broom) ; Apocynum (Cana- 
dian Hemp) ; Triticum. Vascular Diuretics. Kefrigerant Diu- 
retics : Potassium ; Potassium Carbonate ; Potassium Bicarbon- 
ate ; Potassii Acetas ; Potassii Bitartras ; Potassii Nitras ; Potassii 
Chloras 134 

Blennorrhetics : Buchu ; Pareira ; Matico ; Uva Ursi (Bearberry) ; 
Juniperus (Juniper) ; Chimaphila ; Oleum Erigerontis ; Terebin- 
thina (Turpentine) ; Oleum Terebinthinse (Oil of Turpentine) ; 
Copaiba; Cubeba (Cubeb) ; Oleum San tali 139 



CONTENTS. 7 

PAGE 

Cathartics: Laxatives; Salines. Astringent Resin-Bearing Purga- 
tives : Rheum (Rhubarb) ; Senna ; Aloe (Aloes) ; Cascara Sagrada ; 
Frangula. Drastic Purgatives (Hydragogues) : Jalapa (Jalap) ; 
Podophyllum (Mandrake) ; Chelidonium ; Iris ; Euonymus ; Scam- 
monium ; Colocynthis ; Cambogia ; Elaterinum ; Oleum Tiglii 
(Croton Oil). Mercurial Carthartics 144 

Anthelmintics : Santonica ; Spigelia ; Aspidium ; Granatum ; Ka- 

mala; Brayera ; Pepo (Pumpkin) 154 

Emetics : Local Emetics. Systemic Emetics : Ipecacuanha (Ipecac) ; 

Apomorphina (Apomorphine) ; Sanguinaria 157 

Diaphoretics : Stimulating Diaphoretics : Pilocarpus ( Jaborandi) ; 
Liquor Ammonii Acetatis; Spiritis ^Etheris Nitrosi. Nauseant 
Diaphoretics ; Refrigerant Diaphoretics 160 

Expectorants : Nauseating or Sedative Expectorants : Lobelia ; Anti- 
mony; Ipecac; Grindelia. Stimulating Expectorants: Senega; 
Ammonii Chloridum (Ammonium Chloride or Muriate) ; Allium 
(Garlic) ; Balsamum Peruvianum ; Balsamum Tolutanum ; Pix 
Liquida (Tar) ; Terebene ; Terpin Hydrate 163 

Emmenagogues : Director Stimulating Emmenagogues: Sabina (Sa- 
vine) ; Ruta (Rue ; not officinal) ; Petroselinum (Parsley) ; Tan- 
acetum (Tansy) ; Polygonum Hydropiperoides 168 

Oxytocics : Ergota (Ergot) ; Gossypii Radicis Cortex ; Ustilago (Corn 

Ergot) ; Cimicifuga 170 

Irritants 173 

Rubefacients : Sinapis Alba (White Mustard) ; Sinapis Nigra (Black 
Mustard) ; Capsicum (Cayenne Pepper) ; Pix Burgundica (Bur- 
gundy Pitch) ; Pix Canandensis (Canada Pitch) 174 

Vesicants: Cantharis (Cantharides) . . . . 176 

Escharotics : Argenti Nitras Fusus ; Potassa ; Caustic Soda ; Acidum 
Arseniosum ; Zinci Chloridum ; Bromum ; Acidum Chromicum ; 
Hydrargyrum ; Acidum Nitricum 178 

Suppurants . . 181 

Irritants 181 

Demulcents : Aqua (Water) ; Acacia (Gum Arabic) ; Tragacantha 
(Tragacanth) ; Cetraria (Iceland Moss) ; Chondrus (Irish Moss or 
Carrageen) ; Ulmus ; Glycyrrhiza (Licorice) ; Lycopodium ; Linum 
(Flaxseed) ; Amylum , . 182 

Emollients: Lanoline ; Glycerinum ; Saccharin; Petrolatum ... 185 

Protectives : Gun-Cotton ; Collodium (Collodion) ; Gutta-percha . . 187 



I 



8 CONTENTS. 

PAGE 

Antacids : Sodium ; Calx (Lime) ; Liquor Calcis ; Syrupus Calcis . . 188 

Antiseptics, Disinfectants, Germicides: Calx (Lime); Ozone; 

Hydrogen Peroxide; Potassii Permanganas; Acidum Sulphur- 

osum (Sulphurous Acid) ; Hydrargyri Chloridum Corrosivum ; 

Acidum Boricum (Boric Acid) ; Sodii Boras (Borax) ; Aqua Chlori 

(Chlorine-water) ; Calx Chlorata (Chlorinated Lime) 190 

Aromatics 193 

Dietetics: Animal Food; Derivatives of Milk, and their Peculiar 
Properties ; Cream ; Skimmed Milk ; Butter ; Koumyss ; Matzoon ; 
Peptonized Milk ; Eggs ; Beef ; Veal ; Mutton ; Pork ; Chicken ; 
Vegetables; Special Plans of Diet; Diseases of the Alimentary 
Tract; Digestive Ferments ; Pepsinum (Pepsin) ; Pancreatine . . 195 



Table of Doses 205 

Important Poisons and their Antidotes . . 211 

Incompatibilities - ■ 212 

Classification of Drugs 213 



MATERIA MEDICA AND THERAPEUTICS. 



How may Materia Medica be defined? Therapeutics? 

Materia Medica is that branch of medical science which treats of me- 
dicinal remedies, their names, origin, chemical composition, physical 
peculiarities, methods of preparation, their mutual antagonism and 
synergism, and their physiological effects in medicinal and poisonous 
doses. 

Therapeutics teaches of the uses of these remedies in the various 
morbid conditions of the human economy. 

How may medicinal remedies be classified? 

Remedies of this kind may be divided into — 

Hygienic, which are treated of exhaustively in works on this subject ; 

Mechanical, such as venesection, cupping, aspiration, infusion, trans- 
fusion, etc., which fall more appropriately within the realm of minor 
surgery; 

Imponderable, as air, light, heat, cold, and electricity, of which only 
heat and cold will here demand attention; 

Pharmacological, or drugs properly so called, to which, strictly 
speaking, our field is limited : in this sense Pharmacology is synonymous 
with Materia Medica. 

Pharmacy treats of the art of collecting, preparing, and dispensing 
medicines. 

IMPONDERABLE REMEDIES. 

What are the physiological and therapeutic uses of light ? 

The effects of heat and light are hard to dissociate. Light is a stim- 
ulant to all vital functions, and its use is indicated whenever there is im- 
perfect nutrition from any cause. 

HEAT. 

What are the uses of heat and methods of application ? 

Like light, heat is a vital stimulus, a necessity to all organic life. 
Although the normal temperature of the body is remarkably uniform 
(about 98.4°), yet, as is well known, man is capable of exposure to great 
variations of heat and cold without harmful effect. We are not sur- 
prised, then, to find that most of the physiological effects of heat upon 
which depend its uses are of a local nature, not systemic. It is used 
2 17 



18 HEAT. 

as an excitant, evulsive, and analgesic over small areas in the hot-water 
bottle, poultice, etc. , and over large areas to produce vicarious elimina- 
tive action of the skin (diaphoresis) in certain conditions of imperfect 
kidney elimination and in certain cutaneous affections. For this latter 
purpose a more general application is obtained by hot baths — hot-air or 
"Turkish" baths and hot- vapor or "Russian" baths. Dry heat is a 
most valuable resource in combating surgical shock. The Turkish bath 
consists in exposing the subject to a gradual increase of temperature from 
95° to about 155° : an immensely increased activity of cutaneous circula- 
tion results, and consequently a corresponding diminution of that of 
internal organs. These baths are a valuable remedy in the conditions 
mentioned above, but may prove^ dangerous if the patient be the victim 
of extensive cardiac or arterial disorder. 

What are the uses of greater degrees of heat ? 

Heat is also employed to the extent of actual tissue-destruction in vesi- 
cation and cauterization. The thermo- and galvano-cauteries are exceed- 
ingly valuable as counter-irritant, revulsive, and haemostatic measures. 

What are the two thermometric scales in ordinary use ? and how- 
are they compared? 

The Fahrenheit scale is in ordinary use in America and England ; the 
Centigrade is used on the Continent of Europe. 

To Convert Degrees of the Centigrade Scale into those of Fahrenheit : 
Multiply the number of the former by 9 and divide by 5 ; if the temper- 
ature was above the freezing-point (0°), add 32°; if it was below the 
freezing-point, subtract the result from 32°, algebraically. 

To Convert Degrees of the Fahrenheit Scale into those of Centigrade : 
If the temperature be above the freezing-point (32°), subtract 32; if it 
be below the freezing-point, subtract the number from 32, algebraically ; 
then multiply the remainder by 5 and divide by 9. 

What are the effects and uses of cold ? 

The effects of cold are primary and secondary. For the primary effects 
a considerable degree is required. It is efficient by lessening vascular and 
nervous excitement, constringing the tissues, lessening the actual volume 
of parts, and producing local anaesthesia. It is used in nervous disorders, 
as meningitis, chorea, epilepsy, hysteria, etc. , generally as an application 
to head or spine — to abate inflammatory processes and check hemorrhage 
in a variety of conditions. 

The secondary effects of cold are obtained by a lesser degree, but 
applied over a larger area, generally nearly the whole body surface, as in 
the cold bath, wet pack, etc. They are useful as a general tonic in 
debilitated conditions ; as a respiratory stimulant in the narcotic poisoning 
of opium, chloral, alcohol, chloroform, and ether; as antipyretic in the 
hyperpyrexia of insolation (sunstroke), rheumatism, typhoid and other 
continued fevers. 



PHAEMACOLOGICAL REMEDIES. 19 

What is the theory of action of hot and cold applications to the 
spine? 

It is supposed that heat causes stimulation, and cold, paresis, of the 
vaso-constrictor nerves of the parts of the body deriving their vaso-motor 
supply from the section of the spinal cord over which the application is 
made (Chapman). 

Electricity will receive treatment in the treatise on Practice in this 
series. 

PHARMACOLOGICAL REMEDIES. 

What is the modus operandi of drugs ? 

Drugs may act (1 ) locally, usually from some direct chemical effect on 
tissues; (2) constitutionally (systemically or remotely), for which it is 
necessary that they should be absorbed by the capillaries and lymphatics 
into the blood, often undergoing chemical changes in the process. The 
process of absorption is generally proved by finding traces of drug-ele- 
ments in the blood, tissues, and secretions, and also by the fact that if 
circulation be interrupted the influence of drugs is not transmitted. 

What circumstances modify the activity of drugs ? 

Diversity of action may depend on the drug itself as modified by sea- 
son, climate, etc. ; on the pharmaceutical preparation used :^ as the sol- 
ubilities of the active principles of the same drug may vary, it is evident 
that their activity will vary with the solvent used (vide Digitalis, its tinc- 
ture and infusion) ; again, liquid preparations are more potent than solid ; 
on chemical or physiological antagonism or synergism of drugs taken at 
or about the same time ; on age and sex of patient : females require pro- 
portionately smaller doses, unless we except cathartics ; infancy and old 
age bear drugs poorly : however, there are certain drugs, notably bella- 
donna, arsenic, quinine, aconite, and cathartics generally, which are borne 
by children in proportionately larger doses. Young's rule for graduating 

afire 
the dosage for children may be expressed thus : , • Cowling s 

rule is to divide the age at next succeeding birthday by twenty-four. 

On idiosyncrasy of patient : some individuals are peculiarly susceptible 
or the opposite to certain drugs. Thus the writer has seen on repeated 
occasions in the same subject two grains of quinine followed in a short 
time by a severe attack of spasmodic asthma, accompanied by a very 
pronounced and distressing urticaria. 

On habit : certain forms of disease, time of administration as regards 
meals, and the condition of the stomach may all modify effects. 

By what avenues may drugs be administered ? 

(1) By the skin : 

(a) Enepidermatic — application to skin without friction : absorption is 



20 PHARMACOLOGICAL REMEDIES. 

more rapid if chloroform be used as solvent. It is not much used 
because of interference offered by the epidermis and secretions of the 
skin. 

(b) Epidermatic — with friction : systemic effects may be produced, as 
is especially well seen in the inunction of the ointment and oleate of 
mercury or of cod-liver oil in marasmic conditions. 

(c) Endermatic — application of drug to a surface denuded of its epi- 
dermis by vesication : painful, and practically obsolete. 

(2) By the mucous membranes : 

(a) Of g astro-intestinal tract, the most usual method : perfect condi- 
tions for absorption are afforded either in the acid secretion of the 
stomach or the alkaline of the small intestine. Also by rectal enemata : 
when absorption is desired, about §iv of fluid should be injected : dosage 
by rectum is roughly about double that by mouth, or in narcotic drugs 
somewhat less than this. Medicinal and nutritive enemata are very 
valuable in cases of continued vomiting from any cause, inability to 
swallow, or in forced feeding and stimulation. Enemata of defibrinated 
beef-blood have proved most satisfactory in pernicious anwmia. 

(b) Absorption may also take place through the mucous membranes 
of the conjunctiva, nose, throat, bronchi, and genito-urinary tract. 

(3) By the subcutaneous areolar tissue, principally by the hypodermic 
method : usual sites of injection are the arm, thigh, and abdomen, and 
perfect asepsis is required to prevent infection. Under this subdivision 
may also be placed transfusion of blood and infusion of blood, milk, 
saline solutions, etc. 

What are the recognized forms in which drugs are administered ? 

Preparations may be solid, semi-solid, or liquid. 

The solid preparations are as follows : 

Abstracta (abstracts), alcoholic extracts diluted with lactose (milk- 
sugar), and representing twice the strength of parent drug and ten 
times that of tincture. 

Palveres (powders), drugs in finely divided state, and rendered so by 
pulverization, precipitation, or elutriation ; they are a suitable form for 
administration of drugs of pleasant taste, slight bulk, and permanent 
in atmosphere. 

Extracta (extracts). — Extracts are obtained by evaporating liquid 
preparations, as tinctures, infusions, or vinegars, to a solid or semi-solid 
consistency. Extracts of fresh drugs may be alcoholic, acetic, or aqueous. 

Triturations (triturations) are more finely divided than powders : 
strength, 10 per cent, in milk-sugar. 

Pilulce (pills) are small globular masses suitable for the exhibition of 
drugs which are insoluble in the ordinary solvents or offensive to taste, 
but not bulky. 

Trochisci (troches, lozenges, tablets, or pastilles) ; confectlones (confec- 
tions) ; and char tee (papers) complete the list of solid preparations. 

The liquid preparations are— 



PHARMACOLOGICAL REMEDIES. 21 

Liquores (solutions), made by dissolving non-volatile principles in 
water. 

Aquas (waters), solutions of volatile principles in water. 

Misturce (mixtures), which are insoluble substances suspended in water 
by some viscid substance, as gum arabic, tragacanth, or sugar. 

Tincturce (tinctures), or solutions of recognized drugs in alcohol, 
ethereal spirit, or aromatic spirit of ammonia, and known accordingly 
as alcoholic, ethereal, or ammoniated tincture. As these menstrua 
evaporate readily, tinctures should be kept tightly corked or they may 
become seriously increased in strength. 

Infusa (infusions). — In these the virtue of the drug is extracted by 
digestion or maceration in cold or hot (but not boiling) water : cold water 
is used when the active principles are affected by heat or are volatile. 
When boiling water is used, we have a decoction (decoctum). 

Spiritus (spirits) are alcoholic solutions of volatile substances, bearing 
much the same relations to tinctures that aquse do to liquores. 

Vina (wines) are solutions in stronger white wine. 

Aceta (vinegars), solutions in dilute acetic acid. 

In Mellita (honeys) drugs are held suspended or dissolved in honey. 

Syrupi (syrups) are preparations of medicinal substances in concen- 
trated solutions of sugar. Syrupus simplex is 65 parts sugar with water 
to 100 parts, heated. Compound syrups contain other agents in addi- 
tion. 

Extracta Fluida (fluid extracts). — These are very convenient prep- 
arations, produced by partial evaporations of solutions of active prin- 
ciples in alcohol or glycerin. One minim represents one grain of drug 
(1 cc. = 1 gm.). 

Oleoresinas (oleoresins) are extracts of crude drugs by ether, made up 
of fixed or volatile oils holding resins in solution : they are liquids and 
self-preserving. 

Glycerites, Elixirs, Mucilages, and Collodions complete the list. 

The semi-solids are — 

Suppositoria (suppositories), mixtures of medicinal agents in cacao 
butter, melting at the body temperature in rectum, vagina, uterus, or 
urethra. 

TJnguenta (ointments), which are preparations of agents for local use 
in some fatty substance, generally benzoinated lard, or in petrolatum. 

Oleatd (oleates) are combinations of metallic bases or alkaloids with 
oleic acid. 

Cerata (cerates). — In these enough white wax or spermaceti is added 
to render them still solid at the body temperature. 

Ijinimenta (liniments) are thick, oily preparations, always liquid at 
body heat, and intended to be applied with friction. 

Emplastra (plasters) are adhesive at body heat; made in different ways, 
but most often with lead plaster, a compound of olive oil and litharge. 



22 WEIGHTS AND MEASURES. 

WEIGHTS AND MEASURES. 

What two systems are used? What are their terms, symbols, 
and relative values ? 

In the United States, Troy or Apothecaries' Weight is still the stand- 
ard, although the metric system is gradually coming into vogue. 

Troy, or Apothecaries', Weight. 

20 grains (gr.) ==1 scruple O) — 20 grains. 
3 scruples = 1 drachm (3) = 60 u 
8 drachms = 1 ounce (g) = 480 " 

12 ounces = 1 pound (flb) = 5760 " 

Wine, or Apothecaries 1 , Measure. 

60 minims (wi) = 1 fluidrachm. 

8 fluidrachms (fl. dr. ) = 1 fluidounce. 
16 fluidounces (fl. oz.) =1 pint. 

2 pints (O) =1 quart. 

4 quarts = 1 gallon (Cong., C) = 321 cubic inches. 

There are 12 ounces in the Troy pound, but it is seldom used in pre- 
scribing. The scruple O ) is very infrequently seen. 

The metric system possesses the advantage of a single unit for solids 
and liquids, and a decimal system of multiplication and subdivision, thus 
giving it simplicity. Its unit, the gram (gin.), is the weight of 1 cc. of 
distilled water at 4° C. The subdivisions are milligram, centigram, and 
decigram, or respectively xoVo? rio? ana< to gram : its multiplications, 
decagram, hectogram, kilogram, etc., or 10, 100, and 1000 grams. The 
amounts required of liquid substances to equal a gm. vary of course with 
the sp. gr. of the liquid ; aquas are naturally practically gm. for cc. : in 
spirits, tinctures^ and oils the difference is so slight as to be disregarded : 
aether fortior being of low sp. gr. , one-fourth less is ordered ; glycerin 
one-fourth more ; syrup one-third and chloroform one-half more. 

What are the comparative equivalents of Troy and metric weights ? 

A gram is practically equivalent to 15 grains: 3] therefore = gm. 4. ; 
f^j = 31 cc. or gm. Bearing these few points in mind, the transposition 
from one system to the other is easy. Thus, reduce the quantity to 
grains and divide by 15, the quotient representing, approximately, the 
quantity in grams. Or reduce to drachms and multiply by 4. The 
terms decagram, hectogram, and kilogram are seldom used in prescribing, 
their equivalent being expressed in gm. ; thus gm. 10, gm. 100, etc. : 
for subdivision, gm. .1, gm. .01, and gm. .001. 

Drops (guttae, gtt. ) are loosely used as equal to minims, but vary with 
a number of conditions : of tinctures, for the most part, a fluidrachm 
contains about 120 drops, or 2 drops to the minim, while an equal 



CAMPHOR. 23 

amount of chloroform contains over 200. In prescribing less powerful 
liquids a teaspoonful is roughly used as equalling 3j, but it is safer to 
consider six teaspoonsful to the §j ; a tablespoonful for ^ss ; a wineglass- 
ful for §ij ; a teacupful for §iv. 

CLASSIFICATION OF DRUGS. 

Some classification of medicinal agents seems necessary, but, owing to 
the great variety of effects and uses of certain individual remedies, no 
satisfactory arrangement is possible. Various groups, as antispasmodics, 
anaesthetics, somnifacients, delirifacients, cardiac stimulants and depres- 
sants, etc. , to be later defined, are recognized. Our purpose will be to 
treat of each drug in that class in which it finds its chief efficiency, and 
to mention it in its other less important therapeutical asssociations. 



ANTISPASMODICS. 

What are antispasmodics ? 

A class of drugs whose plrysiological effects are not pronounced, acting 
in some unexplained manner on the cerebrum, and especially valuable in 
neurotic conditions, as hysteria, ' ' nervousness, ' ' etc. They are all stimu- 
lant and diaphoretic, and most of them have a strong, peculiar odor. 

CAMPHOR. 

What are the origin and physical peculiarities of camphor ? 

Camphor is a stearopten, derived by sublimation from the roots and 
branches of Camphora cinnamonvum, or camphor laurel, an Asiatic tree. 
It occurs in soft, rather consistent pieces, of hot and peculiar taste and 
cooling after-taste, and of characteristic odor. It is volatile, burns with 
a very smoky flame, floats on water, in which it is quite insoluble and 
by which it is precipitated from its solutions in alcohol, ether, chloro- 
form, and oils. Chemically, it resembles the turpentines, and it forms 
substitution products with the chlorine group. 

What are the preparations of camphor, and their doses ? 
Camphora, dose gr. v to xv ; best given in emulsion or pill. 
Camphora Monobromata (see below) ^ dose gr. v. 
Aqua Camphorae (1 : 125), dose gss-ij. 
Spiritus Camphorae (1 : 10), dose fl^xx-xl. 
Linimentum Camphorae, 20 per cent. , in olive oil, ] 
Ceratum Camphorae (3 : 100), > external use. 

Linimentum Saponis, ) 

What are its physiological effects? 

Camphor is much more active than other members of this group. 
Locally, it is an irritant to skin and mucous membranes, producing 
superficial inflammation of the former, and, when swallowed, symptoms 



24 ANTISPASMODICS. 

of irritant poisoning : it is mildly diaphoretic, stimulant to circulation in 
medicinal, and depressing in larger, doses. Nervous system — small doses 
exhilarate, larger cause headache, dizziness, delirium, convulsions, while 
toxic doses produce convulsions, stupor, and coma. Upon the genito- 
urinary tract large doses exert a decided sedative effect. 

Name its most important therapeutic uses. 

In hysteria :, melancholia, nervous headache^ and dysmenorrhea as a 
sedative ; in typhoid and adynamic fevers as a stimulant diaphoretic ; in 
diarrhoea, dysentery, cholera, etc., generally combined with opium; in 
chronic bronchitis and emphysema, acting as a blennorrhetic and antispas- 
modic; to allay irritation of geni to-urinary tract, as in priapism, chordee, 
nymphomania, dysmenorrhcea, etc. , large doses necessary ; acute coryza 
in its incipiency may be aborted by camphor. 

Its external applications are valuable mild counter-irritants. 

SPIRITUS JETHERIS COMPOSITUS (HOFFMAN'S ANO- 
DYNE). 

What are its component parts and efficient ingredients? 

Hoffman's anodyne is composed of oleum cethereum, 3 per cent. ; 
ether, 30 per cent, in alcohol. It owes its activity to the first two. 
Oleum cethereum, or heavy oil of wine, is obtained by distilling alcohol 
in an excess of sulphuric acid, and adding an equal amount of ether to 
the distillate : it is antispasmodic, but is only used in the above prepara- 
tion. Hoffman's anodyne is a colorless, volatile, inflammable liquid, of 
ethereal odor and burning but sweetish taste, and giving when mixed 
with water a milky color, which is a test for its purity. The color is due 
to the precipitation of the oil of wine, which is expensive and often 
wanting in sophisticated preparations. 

Effects and uses of Hoffmann's anodyne. 

It is an efficient antispasmodic in the distressing attacks of cardiac 
disease, having slight stimulating effects ; also in asthma, hysteria, etc. ; 
also employed as a carminative and anodyne. 

VALERIAN. 

Give its origin and composition. 

Valerian is the rhizome and rootlets of Valeriana officinalis, which 
contains a volatile oil, oleum valeriance, of peculiar odor and yielding 
valerianic acid, valerian camphor, and resin. 

What are its preparations ? 

The number of officinal preparations is out of proportion to its use- 
fulness. The principal are — 
Tinctura Valerianae (1 : 5), dose 3ss-iv. 
Tinctura Valer. Ammoniata (1 : 5), dose 3ss-iv. 



ASAFCETIDA. 25 

Ammonii Valerianas, dose gr. ij-viij. 
Zinci Valerianas, dose gr. j-iij ; a zinc salt. 

The oil, abstract, and fluid extract of valerian, and the valerianates 
of iron and quinine, complete the list. 

-What are its physiological effects and therapeutic uses? 

Valerian is not constant in its action, at times exciting and at others 
allaying reflex excitability — a variability which may be due to the numer- 
ous phases of the condition in which it is most employed. Large doses 
may cause epigastric burning and symptoms of gastric irritation, with 
headache, vertigo, mental exhilaration, and hallucinations, but these are 
not invariable. It probably stimulates slightly the circulation. Its chief 
value has been found in hysterical conditions generally, in which it is 
frequently used ; also used with varying success as an antispasmodic in 
pertussis, asthma, chorea, and spasmodic conditions generally ; but will 
prove most efficient in those of neurotic origin, as laryngismus stridulus. 
The valerianate of ammonia has met with success in neuralgias, nervous 
headache, and hysteria. 

ASAFCETIDA. 

What are its origin and composition? 

Asafoetida is a gum-resin obtained from the exudation following 
incisions into the living root of Ferula nartkex and F. scorodosma. 
Besides gum and resin it contains a volatile oil, which gives the drug its 
peculiar garlicky odor. 

What are the preparations and doses of asafcetida ? 

Asafoetida, gum-resin, dose gr. y-xv. 
Pilule Asafoetidae (in each gr. iij), No. ij-iv. 
Mistura Asafoetidae (milk of asafcetida), dose ^ss-j.^ 
Mistura Magnesias et Asafoetidae (Dewees' carminative) contains 7 per 
cent, of tinct. asafoetidae and 1 per cent, tinct, opii; dose ^\xx. 
Tinctura Asafoetidae (1 : 5), dose 3ss-j. 
A pill of aloes and asafoetida and a plaster are officinal. 

Has it any marked physiological effects ? 

Its effects are disputed. It is probably mildly stimulant and carmin- 
ative ; it increases the secretions of the bronchi and intestines, and gives 
rise to very offensive stools; by some it is claimed to stimulate 
peristalsis. 

What are its therapeutic uses? 

Like valerian, it is of use in hysterical conditions. But from its sup- 
posed expectorant and intestinal effects it is said to have peculiar 
efficiency in spasmodic pectoral affections, in flatulence and tympanites : 
these conditions in children may be relieved by enemata of lac asafoetidae, 
but the odor renders the remedy very objectionable. 



26 ANTISPASMODICS. 

MOSCHUS (MUSK). 
What is musk? 

Musk is the dried secretion from the preputial follicles of Moschus 
moschi ferns, or musk-deer: seldom found in shops, and is apt to be 
greatly sophisticated. 

What are its preparations ? 

Moschus, dose gr. v-xv. 
Tinctura Moschi, dose 3ss-ij. 

What are its physiological effects and its uses? 

On the healthy organism its effects are probably nil. In certain 
adynamic and nervous conditions it may prove exhilarant, stimulant, 
and antispasmodic. It has its advocates in conditions of collapse and 
the adynamic stages of typhoid and alcoholic pneumonias, and may 
prove valuable in hysterical manifestations, singultus, and other spas- 
modic conditions. 

SUCCINUM (AMBER). 

Oleum succini (oil of amber) is a volatile oil obtained by destructive 
distillation from amber, which in turn is a fossil resin of an extinct coni- 
ferous tree [Pinitis succinifer) found along the Baltic shores. 

What are its effects and uses as an irritant and antispasmodic? 

Locally, it is irritant, and has been used in rheumatism and as an 
embrocation in whooping cough. Internally, it is a reputed antispasmodic. 
Dose gr. v to xv in capsule : larger doses may cause gastric irritation. 

HUMULUS (HOPS). 

What are its origin and composition ? 

Humulus is the strobiles (cones) of the Humulus lupulus, or hop-vine, 
having at the bases of their imbricated leaves a yellowish powder, 
omcinally known as lupulinum, and containing among other things a 
bitter principle and a volatile oil. 

What are its physiological effects? Has it practical utility? 

Like other bitters, it is a stomachic tonic, and may be used as such : 
hops may produce diaphoresis, and they exert a slightly sedative effect 
on the cerebrum : they are slight cardiac excitants. Humulus has been 
recommended in combination with tinct. capsici as a substitute for alcohol. 
It exerts a somewhat sedative effect on the genito-urinary tract, and is 
used in abnormal sexual excitement and vesical irritability, meeting with 
the most success in functional conditions. It is a domestic remedy and 
has a number of useless preparations. Dose of the tincture, 3j-iij ; of 
fluid extract, tt\,x-xv; of the oleoresin, gr. ij-v. Lactucan'um, the con- 
crete juice of Lactuca, sativa (garden lettuce), has an officinal fluid 
extract, but is probably inert. 



.ETHER. 27 

ANESTHETICS. 
Define " anaesthetic." 

The term ''anaesthetic," which from its derivation (a, non, and 
aicdjjoiq, sensation) would apply to any pain-allaying measure, has been 
limited to certain sethereal substances administered by inhalation and 
producing unconsciousness, accompanied by loss or diminution of sensa- 
tion, motion, and reflex action. The manner in which they accomplish 
this is still under discussion, and will not engage our attention. Those 
most commonly employed are ether and chloroform. 

JETHBR (ETHER). 
What are aether, its chemistry, and its preparation ? 

Ether is ethyl oxide # (C 2 H 5 ) 2 0, and is formed by the dehydration of 
ethyl alcohol by sulphuric acid (hence called sulphuric ether), and subse- 
quent purification by calcium chloride, by which the alcohol and acid 
impurities are removed. 

JEther. — The officinal ether contains 74 per cent, of ethyl oxide and 26 
per cent, of alcohol. It is chiefly used as a solvent for oils, resins, gutta- 
percha, etc., although it produces essentially the same effects as — 

jEther Fortior, 94 per cent, ethyl oxide, a thin volatile liquid of pun- 
gent odor, soluble in 8 parts of water, and easily in all ordinary solvents 
(alcohol and chloroform in all proportions). It is inflammable, explodes 
forcibly when ignited, and boils at about the body-temperature (98.6° F. ). 
Its sp. gr. is about 0.725, but its vapor sinks, being heavier than the 
atmosphere ; hence artificial lights should be placed above it. 

What are the physiological effects of ether inhalations? 

Two stages are recognized. The first, or so-called stage of excitement, 
is characterized by a choking sensation, coughing, and other symptoms 
of irritation of the respiratory tract ; then succeed mental excitement, 
lightness of the head, buzzing in the ears, and a variety of emotional 
disturbances (laughing, weeping, shouting, fighting, etc. ) ; the patient 
can still be somewhat aroused. At the end of the first stage a tetanic 
condition occurs, with cyanosis and great muscular rigidity. The second 
stage begins with complete unconsciousness, upon which loss of suscepti- 
bility to pain quickly supervenes, with abolition of reflexes and, generally, 
complete muscular relaxation (although rigidity may last much longer, 
especially in alcoholic patients). The portions of the body retaining sen- 
sibility longest are the eyes and muco-cutaneous junctions. All nervous 
centres are suspended except the medulla, which continues to preside 
over the organic functions of respiration and circulation. If pushed, 
death results from respiratory paralysis, although of late claims have 
been made that heart failure may, in some cases at least, occur first. 
Early in anaesthesia there is cardiac and vaso-motor stimulation ; later, 
the blood- pressure falls. 



28 ANAESTHETICS. 

What effects has ether internally? locally? 

It is antispasmodic and anodyne, with slight primary stimulant effect. 
Hypodermically, it is valuable in collapse as a cardiac stimulant. Lo- 
cally applied, it evaporates quickly and causes coolness and slight anaes- 
thesia of the parts. 

What preparations contain ether? 

iEther. See above. 

iEther Fortior, used for anaesthesia ; by mouth, dose 3ss-j. 

Spiritus iEtheris (one-third aether and two- thirds alcohol), dose 3j-iij. 

Spiritus iEtheris Compositus (antispasmodic), dose 3ss-ij. 

Spiritus iEtheris Nitrosi, dose 3ss-j. 

The last is known as " sweet spirit of nitre," and is an alcoholic solu- 
tion of ethyl nitrite, containing about 5 per cent, of ether (to be consid- 
ered later). 

CHLOROFORM. 

What is chloroform ? Its properties ? 

Chloroform is methynyl chloride or terchhride of formyl (CHC1 3 ). It 
is a colorless fluid of neutral reaction, hot and sweetish taste, and peculiar 
pleasant odor: it is less soluble in water than ether, freely soluble in 
other solvents, and is itself a very good solvent for fats, resins, some of 
the balsams, and many alkaloids. It is also called methylic ether. 

What are the physiological effects of chloroform inhalation? 
How are they different from aether? 

When inhaled the effects resemble those of ether, but are much more 
rapid and powerful, and marked by an absence of faucial irritation 
when given in the proper dilution with air (about 3J per cent.). 
Complete anaesthesia takes place in from one-half to two minutes, while 
the average for ether is eight to ten minutes : there is less liability to 
unpleasant sequelae, as vomiting, etc. , and the patient regains conscious- 
ness earlier. The pupils dilate at first, then contract during profound 
narcosis, and a second dilatation warns that a danger-point has been 
reached. 

Circulation. — Authorities agree that it is more depressing to the 
heart than ether, that the arterial tension is lower, and that death takes 
place generally from cardiac paralysis, but in rare instances from arrest 
of respiration : these unpleasant symptoms may occur with hardly any 
warning. Locally, undiluted, it is decidedly irritant, and vesicates when 
evaporation is prevented. By mouth its effects resemble those of ether 
closely — anodyne and antispasmodic. 

What are the preparations of chloroform, and their uses ? 

Chloroformum yenale, commercial chloroform, not used in medicine 
except locally. 



CHLOROFORM. 29 

Chloroformum Purificatum, purified chloroform, should have a sp. gr. 
of at least 1.485 ; seldom used internally; is the form for inhalation. 

Mistura Chloroformi (chloroform 8 per cent., camphor 2 percent.), 
dose Jss-j. 

Spiritus Chloroformi (10 per cent.), dose tt\,x-3j. 

Linimentum Chloroformi (chloroform 40 per cent., soap liniment 60 
per cent.). 

What uses have ether and chloroform? 

Anaesthesia by these agents is indicated in operative surgery, where 
they find their chief utility ; during the second stage of labor, not to full 
anaesthesia., ether may be used, but chloroform seems safer here than in 
other conditions, and is probably preferable. 

In dislocations and fractures they are valuable by overcoming muscu- 
lar spasm both for diagnosis and reduction ; in convulsions of all kinds ; 
in the diagnosis of hysteria and malingering from actual disease. 

Internally, they correspond closely, chloroform having the advantage 
of being more palatable. In their various preparations they are used 
in gastralgia, colicky pains, dysmenorrhoea, hysteria, and as vermifuges. 
Chloroform is said to abort malarial paroxysms, and its liniments are 
standard local remedies for chronic rheumatism and neuralgia. 

When are ether and chloroform contraindicated ? 

In cardiac disease, either valvular without compensation, or when 
structural changes exist in walls ; in cerebral tumors and cerebral endar- 
teritis the primary congestion may produce hemorrhage; in chronic 
alcoholism : these patients bear anaesthesia badly ; in advanced pulmo- 
nary disease, ether especially; in nephritis, ether may cause uraemia, and 
chloroform is to be preferred. 

State some of the comparative advantages of each. 

Ether, being undoubtedly less liable to cause death, is to be preferred 
in all cases except the following, in which chloroform is more available : 
in hot climates, ether boiling at less than 100° ; in military practice, 
chloroform is less bulky and expensive ; in young children, it is less apt 
to cause fright ; in diseases of stomach and kidneys, less danger of nausea 
and uraemia ; or when artificial light is needed or cautery about face. 

Give some important details in producing anaesthesia. 

The stomach should be empty ; if ether, the patient should be warned 
of the unpleasant features and assured that all will be well ; all foreign 
substances or loose teeth should be removed from the mouth ; the patient 
should be put in the recumbent position, with head turned to one side, 
and all clothing liable to cause respiratory embarrassment loosed ; the 
patient and his friends should always understand that there is some 
danger in the process. 



30 ANAESTHETICS. 

What is to be done when toxic symptoms occur? 

During Ether Anaesthesia. — When dangerous symptoms arise, sus- 
pend the anaesthetic, draw the tongue forward, give atropine or strych- 
nine hypodermically, and if necessary artificial respiration and faradiza- 
tion of respiratory muscles should be employed. 

During Chloroform Anaesthesia. — Stop its administration, and imme- 
diately invert the patient, head downward : ammonia, alcohol, digitalis, 
or strophanthus may be given hypodermically, or amyl nitrite by inha- 
lation. 

When either is taken internally in toxic amount, treat as a case of 
irritant poisoning. 

NITROGEN MONOXIDE, OR LAUGHING GAS. 

What is its preparation? 

This non-officinal gas, so much used in dentistry, is prepared by heat- 
ing ammonium .nitrate, decomposing it into water and nitrogen monoxide. 

What are the effects of laughing, gas? 

Inhaled, it produces in from one to three minutes anaesthesia, preceded 
by a period of excitement, with hilarious, pugnacious, or erotic sensa- 
tions : its modus operandi is not known, but it is probably more than 
pure asphyxia. It may be used as an anaesthetic in brief minor surgical 
operations, being comparatively harmless. 

What other anaesthetics can you mention? 

Ethylene Bichloride : acts rapidly, and powerfully ; liable to cause 
sudden paralysis, but is safer than chloroform. 

Methylene Bichloride : more disagreeable and probably more dan- 
gerous than chloroform. 

Ethyl Bromide or Hydrobromic Ether : dangerous and uncer- 
tain. 

LOCAL ANAESTHESIA. 

What were the older methods of producing local anaesthesia? 

Slight local anaesthesia has been produced by the topical application of 
carbolic acid, chloroform, tincture of aconite, veratrine, certain volatile 
oils, as those of peppermint and bitter oil of almonds, and by dilute 
hydrocyanic acid. ^ A method still somewhat in vogue is the production 
of cold by the rapid evaporation of volatile substances, as ether or rhigo- 
lene. These means, however, have been practically superseded by the 
advent of cocaine. 

COCAINA, OR CUCAINA (COCAINE). 

What is cocaine, and how does it act ? 

The alkaloid of Erythroxylon coca, (cuca), containing a larger or smaller 
percentage of hygrine, an alkaloid of mydriatic powers. Cocaine, the 



OPIUM. 31 

local effects only of which now concern us, acts when in contact with 
nerves of sensation or special sense as an anaesthetic. The skin forms a 
barrier against these effects, while it is readily efficient when applied to 
the conjunctival or nasal mucous membranes : repeated applications are 
necessary to render the mucous membranes of pharynx and vagina insen- 
sitive. The tissues are at first constringed from vaso -motor stimulation, 
but a reactionary congestion soon follows. Slight paresis of motor nerves 
may also be produced (Wood). The skin barrier is overcome by its hy- 
podermic use : the cocaine solution (2 to 8 per cent.) should be injected 
just into the skin, and not deeply in the tissues : the hydrochlorate is the 
salt used and forms a watery solution. Greater efficiency is secured in 
the extremities by controlling the circulation with an elastic band (Com- 
ing's method). Otherwise it is partially carried away by the circulation. 
Laparotomy even may be performed under its use. 

In what conditions is cocaine anaesthesia valuable? 

In the minor surgical operations of ophthalmic, laryngological, gyne- 
cological, and general practice. Bony structures are with difficulty ren- 
dered insensitive, and ether is more suitable. 

In pruritus ani and pruritus vulvas, anal fissure, and other painful con- 
ditions its topical use affords great relief. 

In neuralgias by injection into neighborhood of the affected nerve- 
trunk at any point proximal to seat of pain. 

In hay asthma repeated applications are said to permanently contract 
the turgescent vessels, but some cases at least are not cured, although all 
are alleviated. 

Gastralgia from gastritis or gastric ulcer, and persistent vomiting, may 
yield to its internal administration in doses of gr. i to j of the hydro- 
chlorate. 

HYPNOTICS (SOMNIFACIENTS). 

Into what two classes may these be divided? 

This class of drugs, known also as narcotics^ may be subdivided into 
those which have a pain-allaying effect (analgesics), of which opium is a 
notable example, standing in many respects alone, and the pure hypnotics, 
or sleep-producing agents, the number of which has recently been much 
augmented. 

OPIUM. 

What are its origin and chemistry? 

Opium is the concrete juice obtained by incisions into the unripe cap- 
sules of Papaver somniferum, or opium poppy, containing from 9 to 14 
per cent, of morphine, and other alkaloids in smaller proportions. 

What are the physical properties of opium? 
Good opium is of a fine chestnut color, dense consistency, and a strong 



32 HYPNOTICS. 

characteristic odor. It should break with a deeply -notched fracture, and 
when drawn across white paper should leave an interrupted stain. It 
has a bitter, acrid taste, and imparts its activity to water, alcohol, and 
diluted acids. 

What are its preparations ? Their strength and doses ? 

Opii Pulvis should contain from 12 to 16 per cent of morphine ; used 
in making most of the opium preparations ; dose gr. ss to ij. 

Opium Denarcotizatum : deprived by ether of its narcotine ; 14 per 
cent, morphine, thus less varying than the powder; dose gr. ss-ij. 

Pilula Opii : each gr. j : hard opium pills may be borne better by an 
irritable stomach. 

Extractum Opii : thrice the strength of opium ; dose accordingly. 

Emplastrum Opii ; has very little utility. 

Trochisci Grlycyrrhizae et Opii, each gr. ^ of extract. _ 

Pulvis Ipecacuanha et Opii (Dover's powder); opium and ipecac 
powders, of each gr. j of lactose to gr. x ; dose gr. x. 

Tinctura Opii (laudanum) ; 10 per cent, of powder : dose wix to xij 
(20 to 30 drops), equal to gr. j of opium ; favorite for enemata, and now 
seldom used by mouth. 

Tinctura Ipecacuanhae et Opii ; w\,x = opium gr. j. 

Tinctura Opii Camphorata (paregoric) ; contains opium gr. ij to ^j 
and a variety of other ingredients, including camphor in same amount ; 
used for children ; dose gss for adults, proportionately smaller for chil- 
dren ; forms 12 per cent, of mist, glycyrrhizae comp. 

Tinctura Opii Deodorata ; narcotine and odorous principles removed 
by ether ; strength and dosage same as laudanum. 

Ace turn Opii (black drop) ; also 10 per cent. ; dose see Laudanum. 

Vinum Opii (Sydenham's laudanum) ; 10 per cent, opium ; dose 
TtLxij or gtt. xxv. 

Mistura Magnesiae et Asafoetidae ; contains 1 per cent, laudanum. 

The alkaloids and their salts are — 

Morphina, for pharmaceutical use principally. 

Morphinae Acetas, ] 

Morphinae Sulphas, > dose gr. \ to gr. \. 

Morphinae Hydrochloras, J 

Pulvis Morphinae Compositus ; contains of morph. sulphate 1 part, 
with 20 parts each of camphor, licorice, and calcium carbonate ; known 
as Tally' 's powder ; dose gr. x. 

Trochisci Morphinae et Ipecacuanhae ; morphine sulphate gr. -£$ and 
ipecac gr. T V in each. 

Codeina, gr. ss to ij ; about four times weaker than morphine ; a 
favorite in cough medicines and diabetes. 

Name some important unofficinal preparations. 

Liquor Magendie (" Magendie's solution") is much in use for hypo- 



opium. 33 

dermic purposes ; contains gr. xvj to aq. ^j of morph. sulph. ; dose 
3j = gr. ij, 3ss == gr. j ; an ordinary dose hypodermieally is u\,vj to x. 
Liquor Morphinae Sulphatis (U. S. solution) ; dose gr. j : gj. 

What are the physiological effects of opium ? 

The effects of opium yary decidedly with the size of the dose. Small 
doses, in persons unaccustomed to the drug, produce at first a sense of 
well-being, stimulation of the mental faculties, especially the imagina- 
tiye (probably due to lessened restraint by blunting of the highest mental 
endowments, as judgment, etc.), followed by a blissful dreamy state, 
merging more or less quickly into a sleep which may be disturbed or 
restful, and from which the patient awakes either refreshed or with more 
or less headache, nausea, and depression. Larger Doses. — When large 
medicinal doses haye been administered the period of stimulation is 
shorter, the sleep more profound, the pupils are somewhat contracted, 
sweating may ensue, and the symptoms of depression and gastric dis- 
turbance more marked. When very large doses haye been taken the 
patient sinks almost at once into a profound sleep, with slow and noisy 
breathing, slow full pulse, and minutely contracted pupils, while the skin 
gets cool and becomes covered with clammy perspiration. After fatal 
doses stupor, coma, stertor, respiratory and circulatory depression occur, 
and finally death from paralysis of the respiratory centre. 

What are its effects on different bodily functions? 

The effects seriatim, and their explanations on physiological grounds 
as far as known, are as follows : 

Nervous System. — A progressive paralysis, involving in succession the 
cerebral, sensory, and reflex functions, and finally the important centre 
in the medulla. 

Circulation.— A primary acceleration of pulse-rate, followed by a slow 
full pulse and increased (?) arterial pressure : these effects are # due to 
stimulation of inhibition and of the cardiac muscle. After toxic doses 
a rapid and feeble pulse from paralysis of the same. 

Respiration^— Opium slows respiration by a centric effect; in poison- 
ing the respirations may be as infrequent as one a minute or even less. 

Pupils. — Generally equally contracted, and after large doses very much 
so— a centric effect, as it does not occur when instilled into the eye. All 
secretions except perspiration are decreased ; the urinary solids may be 
increased or decreased, but the fluids are always diminished; retention 
of urine may occur. 

Digestion.— Secretions and peristalsis diminished; as a direct conse- 
quence, digestive impairment, with anorexia, nausea, and constipation, 
results. 

What are the chemical and physical properties of morphine ? 

This alkaloid, representing practically the medicinal and for the most 
part the physiological powers of opium, occurs in colorless crystals, odor- 

3— M. M. 



34 HYPNOTICS. 

less, but of very bitter taste. Owing to its own insolubility, its salts, the 
sulphate, hydrochlorate, and acetate, are most frequently used : to obtain 
the same effects from these about one-fourth more should be given 
than of morphine. Morphine should average 14 per cent, in good 
opium (12 to 16 per cent) ; hence gr. i about equals gr. 1. 

How does morphine differ from opium? 

Morphine differs from opium in being less apt to derange digestion, 
less constipating, less diaphoretic, and less tetanizing, while it is more apt 
to cause pruritus, is more hypnotic and analgesic, and probably more of 
a cardiac stimulant ; retention of urine is less apt to occur under its 
use. 

What may be said of codeina ? 

Codeine is present in small amount (0.03 per cent,). The physiological 
powers of this alkaloid are not clearly understood ; it probably, as used, 
has varied in composition, which alone would explain the conflicting 
reports upon its effects. 

What other alkaloids are contained in opium? 

Besides morphine and codeine, opium contains a number of other 
alkaloids, the most important of which are — 

Thebaine or paramorphine, ] 

Laudanine, >■ tetanizing agents. 

Porphyroxine, J 

Narcotine, to which some attribute the unpleasant gastric effects. 

Narceine, papaverine, meconine, cryptopine, and hydrocotanine have 
been somewhat investigated. 

Opium also contains various acids (meconic, theobolactic, and sulphuric), 
gum, extractive, and a volatile odorous principle, the last of which shares 
with narcotine the reputation of being the nauseant principle. 

Treatment of acute opium-poisoning. 

Very small doses have proved fatal in children, and gr. i of morphine 
is said to have caused death in a feeble adult. When toxic symptoms 
develop after a moderate dose, or when a presumably toxic dose has been 
taken — 

Empty the stomach at once, preferably with the stomach-pump or gas- 
tric siphon — the latter may be improvised from a rubber tube and fun- 
nel—or emetics may be given : mustard, being generally available, may 
be given in ^ss dose and repeated in ten or fifteen minutes, or the sid- 
phates of copper or zinc in large doses. 

Next give chemical and physiological antidotes to neutralize the 
remainder — tannic "acid, strychnine, or atropine; the last should be 
administered tentatively in small doses, guided by its physiological effects, 
especially on respiration. 

Remainder of treatment consists in various measures to maintain res- 
piration, such as walking patient about, flagellation, hot and cold affu- 



opium. 35 

sions, faradism, and, if necessary, artificial or forced respiration and 
oxygen inhalation ; strong coffee is valuable, given by mouth or rectum. 

Give some symptoms and cures of chronic opium-poisoning or 
habit. 

Toleration of the drug may be greatly increased and incredible amounts 
consumed. The digestive and nervous systems are most affected ; the 
subject loses mental and moral tone ; if rapidly increasing amounts be 
taken, great deterioration of the general health may ensue. 

Treatment of the habit is very often only temporarily effectual : the 
drug may be withdrawn immediately or ' ' tapered off. ' ' Much depends 
on careful attention, nursing, feeding, and moral support. The simple 
hypnotics may be given and stimulating nutritious food ; beware of 
"opium cures," which generally contain morphine; no drug takes its 
place. On withdrawing the drug a diarrhoea may be set up and require 
very careful treatment. Proplrylaxis is all-important. 

What are the therapeutic indications for opium or morphine ? 

This drug is indicated and is a most valuable remedy in pain of all 
descriptions, as the various neuralgias and colics — a most potent analgesic ; 
as an antispasmodic in certain conditions, notably spasmodic asthma, 
which may frequently be aborted by its hypodermic use ; also in spasm 
of glottis and lead colic; in diarrhoea and dysentery opium combined 
with astringents is the most available treatment. 

In peritonitis comparatively large doses are given, acting by allaying 
pain, decreasing peristalsis, and, in early sthenic stages, by some direct 
antagonism to the inflammatory process itself (antiphlogistic). 

In cholera morbus, invaluable hypodermically. 

In beginning inflammation of pleura and lungs and in acute coryza it 
seems to lessen activity of process. 

In hemorrhages and in the distressing paroxysms of valvular disease, 
morphine subcutaneously. 

In true diabetes, codeine preferably ; also in diabetes insipidus ; in 
urcemia, hypodermically and with care ; in acute diseases, as the exan- 
themata; in distressing cough. 

Its use is warranted in the last stages of chronic disease and in small 
amounts in old age ; as hypnotic only in very rare cases. 

How is it administered ? and with what cautions ? 

Opium may be administered by mouth, by rectum, or subcutaneously 
as the conditions demand. It should never be given as hypnotic when 
simpler measures are adequate, is contraindicated in coma of any kind, 
and caution should be exercised in using it in cerebral conditions, uraemia, 
respiratory embarrassment, delirium tremens, or when possibility of her- 
nial strangulation exists. Never follow a dose of opium or its synergists 
by another dose subcutaneously, for the two may take effect at the same 
time. Remember^ that children bear opium badly, and that certain 
adults have an idiosyncrasy. 



36 HYPNOTICS. 

CANNABIS INDICA AND CANNABIS AMERICANA. 

What are these drugs? 

Indian and American hemp, the flowering tops of Cannabis sativa as 
grown in India and America, the former being the more active and the 
recognized source of the officinal preparations. It is used in India as a 
narcotic stimulant under the various names of haschisch, bhang, churrus, 
and gunjah. 

What are the officinal preparations of cannabis? 

Extractum Cannabis Indicae ; most used ; dose gr. J-j. 
Extractum Cannabis Indicae Fluidum, dose n\j-x + . 
Tinctura Cannabis Indicae (20 per cent), dose 3ss. 

Describe its physiological action. 

There are two stages: (1) characterized by mental exhilaration, fol- 
lowed by (2) drowsiness and sleep. After a dose varying with efficiency 
of drug and the temperament and surroundings of the patient a condition 
of peculiar agreeable mental exhilaration is felt ; the ideas flow quickly, 
and sense of duration of time and extent of space is lost. There are 
greater or less cutaneous anaesthesia, a sensation of weight in limbs, and 
some muscular incoordination from loss of muscular sense. Hallucina- 
tions and mild delirium may occur. Then succeed drowsiness and sleep, 
from which patient awakens with some depression. Cannabis differs from 
opium in not affecting respiration, in that it dilates the pupils, and in not 
lessening the secretions. The circulation is not affected. No fatal cases 
are recorded. 

To what does it owe its activity? What is its administration? 

A volatile oil and a resin, cannabin. The extract is most commonly 
used, but is of very uncertain strength, and it is soluble in alcohol and 
ether, but not so in water. 

In what conditions may cannabis be used? 

Its uses are fewer than formerly. It has been used in tetanus, chorea, 
and hysteria as an antispasmodic ; in neuralgias, muscular rheumatism, 
and migraine as an analgesic. 

As an hypnotic it has been used, but is of uncertain strength and not 
now in favor, while as an anaesthetic it is useless. Tannate of cannabin 
is also an uncertain hypnotic. 

CHLORAL (CHLORAL HYDRATE). 

What chemical features has chloral? 

Chloral is a thin, oily, colorless liquid, prepared by leading chlorine 
gas through anhydrous alcohol, the results being chloral and hydrochloric 
acid, which separate in layers, the lowermost of which is chloral. It is 
purified by distillation with sulphuric acid and quicklime. Chloral is not 
itself used in medicine. 



CHLORAL. 37 

What is chloral hydrate? 

Chloral hydrate is not a true hydrate, but a combination of a chloral 
element with an entire molecule of water. It is a colorless, crystalline, 
deliquescent salt of disagreeable taste, more stable than chloral, and 
freely soluble in water, alcohol, or ether. 

What are its physiological effects? 

Locally, chloral is an irritant, and occasionally causes gastro-intestinal 
irritation. In medicinal doses of gr. xv-xx the principal effect of chloral 
hydrate is a quiet, natural, and refreshing sleep. Larger doses cause 
profound sleep, diminution of reflexes, depression of respiration, depres- 
sion of cardiac force and capillary dilatation, slightly contracted pupil, 
muscular weakness, and perhaps a certain degree of anaesthesia. Toxic 
doses are followed by coma, and cause death by stoppage of respiration, 
circulation, or both simultaneously. The supposed transformation into 
chloroform by the alkaline blood probably does not occur. In large doses 
it lowers the bodily temperature decidedly. 

What are its uses? 

The chief uses of chloral hydrate, medicinally, are hypnotic and anti- 
spasmodic. _ It is used as an hypnotic in sleeplessness not dependent on 
pain, as in insomnia from overwork or hysteria, acute mania or delirium 
tremens, succeeding the better the more purely nervous the cause. It 
is used as an antispasmodic in puerperal, urcemic, infantile, or strychnine 
convulsions, in all of which, administered by rectum or mouth, it is very 
efficient in palliating until other curative measures can be tried ; in teta- 
nus — large percentage of cures reported by some, while with others it 
has failed ; trismus neonatorum also ; whoopiny cough and choreic spasm 
are alleviated ; sea-sickness and the vomiting of pregnancy and other neu- 
rotic vomiting may be checked by chloral combined with recumbent posi- 
tion and proper diet ; in conditions of high arterial tension it affords 
relief. 

Chloral hydrate is used by some obstetricians to relax a rigid cervix 
uteri and to relieve the pains of labor. This is the only condition in 
which it is analgesic in safe doses. It is a good antifermentative, and as 
such it is used to prevent decomposition of urine ; added to liq. Magend. 
in small percentage it renders it more stable. 

What two forms may chloral-poisoning take? 

Acute and chronic. 

Acute Poisoning. — The principal symptoms are profound depression 
of respiration and circulation, stupor and coma, suffusion of conjunctivae, 
and muscular weakness as shown by the dropping of lower jaw. Treat 
as for opium-poisoning, avoiding, however, anything (as forced exercise) 
which causes muscular exertion on the patient's part, and watching the 
heart's action closely. Dry heat is a valuable measure. 

Chronic Poisoning. — The continued abuse of chloral hydrate may 



38 HYPNOTICS. 

cause mental weakness, dementia, and in some cases paralysis or paresis ; 
respiratory disturbance, as pronounced dyspnoea ; cutaneous eruptions, 
probably from continued dilatation of the superficial capillaries, taking 
the form of erythema or urticaria (especially after chloral and alcohol), 
catarrhal pharyngitis, and many other rarer effects. 

What is the administration of chloral hydrate ? 

Dose gr. x to xx, the latter being as large as is consistent with safety, 
to be given in some agreeable syrup. Rectal administration may prove 
convenient or necessary in conditions ; it is readily absorbed and dose is 
is the same as by mouth. Alkalies are incompatible, forming chloroform. 
Caution is necessary when any cardiac lesion exists. 

What is croton chloral? 

A crystalline substance freely soluble in water, and possessing effects 
similar to, but weaker than, chloral hydrate, with the added power of 
causing, it is said, anaesthesia of the head and face. It is very little 
used, except in trifacial neuralgia. 

OHLORALAMID. 

What is chloralamid ? and with what is it incompatible? 

A product of chloral hydrate and formamid, occurring in colorless 
crystals of somewhat bitter taste ; slowly soluble in 1 9 parts of water, 
and easily so in alcohol, from which solution it is not precipitated by water. 
It is decomposed by alkalies and by a temperature of 140° F. : hence 
should never be prescribed in warm solutions. 

What effects does it produce? How is it different from chloral? 

Containing, as it does, about two-thirds by weight of chloral hydrate, 
we would expect to find it acting similarly, but this is not t*ue through- 
out the entire range of its action. Upon the respiration and circulation 
in proportionate dosage its effects are almost nil, although slight decline 
in blood-pressure may follow large doses. It is entirely non-irritating 
even in strong solutions, and gives rise to no digestive disturbances. It 
acts feebly upon the spinal cord, but upon the cerebrum its effects are 
pronounced (Wood). In medicinal doses (gr. xxx) it induces a natural 
and refreshing sleep, lasting from six to nine hours, and is in most cases 
entirely free from any unpleasant accompanying or after-effects. Large 
doses (gr. xlv to 3j) occasionally cause headache, dizziness, nausea, and 
slight intoxication. It seems to a slight degree analgesic, but its prin- 
cipal use will be as a pure hypnotic. One theory of its action is that a 
slow conversion takes place into chloral hydrate by the alkaline blood, 
the absence of depression being ascribed to the slowness with which this 
takes place, and also to a possible stimulant effect by the formamid ele- 
ment. So far, neither k ' habit" nor "tolerance" has been noted. It 
is cheaper than sulphonal, acts more quickly, and is apparently as free 



POTASSII BROMIDUM. 39 

from depressing effects. It should be given in a dose of gr. xxx (or gr. 
xv repeated) and in alcoholic solution. 

POTASSII BROMIDUM. 

What are the preparation and properties of potassium bromide? 

The bromide of potash is prepared by the reaction of ferrous bromide 
and potassium carbonate, the potassium bromide remaining in solution 
and crystallizing on evaporation. It is a colorless, crystalline, anhydrous 
salt, of saltish taste, easily soluble in water, as are all the bromides in 
common use, that of sodium being least so (1 : 12). 

What are its physiological effects? 

Locally applied, it obtunds the sensibility of mucous membranes. 

Nervous System. — Upon the cerebral cortex it exerts a marked sedative 
effect, and especially diminishes the irritability of the motor area. These 
effects are due to anaemia from vaso-motor spasm (?) or to a direct action 
on the nervous tissues. Reflexes are diminished, from paralysis partly 
of reflex centres and partly of afferent nerves and their end-organs. 
Painful and tactile sensations are diminished, but the motor nerves are 
not affected. 

Circulation. — The activity of the heart is lessened, the pulse becoming 
slower, with lengthened diastole, from sedative effect on the sympathetic 
system. On vaso-motor apparatus its effects are still subjudice. Arterial 
tension is probably lowered. 

Respiration is diminished in frequency, and a slight fall of temperature 
occurs. Exhalation of C0 2 is lessened. 

Secretions are increased, but, unlike the iodides, it produces no 
lachrymation, salivation, or naso-pharyngeal catarrh. Large doses may 
cause diarrhoea. The urinary effects appear to vary, the excretion of 
urea being probably lessened^ It exerts a marked sedative effect on the 
genito-urinary tract, the vesical irritability being lessened and genital 
excitement allayed. The drug is slowly eliminated in its own form 
in all the excretions, but principally those of the kidney, skin, and 
intestines. 

What are the symptoms of bromism ? 

Acute poisoning does not occur. After continued use bromism occurs, 
a chronic poisoning which may result in death. The symptoms of this 
condition are anaemia and malnutrition, mental weakness and aberration, 
somnolence, hallucinations, and even a mild form of mania ; an eruption, 
generally of acne and occasionally eczematous ; hoarseness, aphonia, loss 
of co-ordination, and a feeling of muscular weakness ; loss of sexual 
desire and impaired sensibility of the mucous membranes, as is well seen 
in the pharynx, titillation of which does not excite retching. 

These symptoms subside on withdrawing the drug, and are less severe 
when it is administered with Fowler's solution or when the mixed 
bromides are taken. 



40 HYPNOTICS. 

In what conditions is bromide of potassium employed ? 

This drug acts as a hypnotic in conditions of mental excitement, 
hysteria, and nervous over-excitability generally. Combined with chloral 
it is valuable in delirium tremens. In the restless forms of insanity it 
is well combined with chloral or cannabis indica, but is contraindicated 
in melancholia. 

As an antispasmodic it is valuable in the reflex vomiting of pregnancy, 
nausea marina, uterine disorder, or migraine; in tetanus, probably con- 
stituting the best treatment when given in large doses ; in chorea, whoop- 
ing cough, and convulsions generally as an adjuvant to other measures. 

From its sedative effect on the genito-urinary organs it is useful in 
nymphomania, chordee, excessive venereal desire, masturbation, sperma- 
torrhoea, etc. It is also of avail in the nervous disturbances of the 
menopause. Neuralgias may be benefited if not dependent on anaemia. 
Its greatest efficacy, however, is in the treatment of epilepsy. It suc- 
ceeds better in grand than petit mal, but is often useful in the latter. It 
should be given in large doses until mild bromism is produced, and must 
be continued for a long period after attacks have ceased. Tachycardia of 
functional origin or symptomatic of exophthalmic goitre is often relieved. 

How is it administered, and with what cautions ? 

Dose gr. xv to Sj or more in elixirs or syrups ; its saline taste may be 
lessened by the addition of sodium bicarbonate. It should not be long 
continued in conditions of malnutrition or anaemia. 

SODIUM BROMIDE. 

How does it compare with the potassium salt ? 

The preparation, chemical and physical properties, and uses of this 
salt correspond closely with those of potassium bromide. It is less 
disagreeable to the taste, less depressing, and by some is considered to 
be less liable to cause symptoms of bromism. 

AMMONIUM BROMIDE. 

It is formed by the precipitation of a solution of bromide of iron by 
aqua ammoniae, the desired salt remaining in solution. It is crystalline, 
but not permanently so, and is more often seen as a powder. It is 
analogous to the potassium compound, but is somewhat less active and 
more disagreeable to the taste, and causes more gastric irritation. By 
some it is said to be less depressing to the heart, but probably all the 
symptoms of bromism may be caused by it. Its physiological action is 
not fully understood. It does not so readily produce acne. It may be 
used to fulfil the same indications as potassium bromide, and especial 
efficacy is claimed for it in pertussis and acute rheumatism. 

What other preparations have similar effects ? 
Lithium Bromide, an expensive salt with no particular advantages, 



SULPHONAL. — AMYLENE HYDRATE. 41 

contains a larger proportion of bromine than other bromides. It is said 
to have proved efficacious in some cases of epilepsy in which other 
bromides have failed. Dose, gr. xv to 3ss. 

Acidum Hydrobromicum Dilutum, a 10 percent, solution of the 
gaseous hydrobromic acid in water, acting much like the bromides, but 
being more irritant to stomach ; it should be well diluted. Indications 
as for bromides. It is also used as a corrigent to quinine, preventing 
the headache and tinnitus aurium so often caused by that drug. Dose 
in its officinal dilution, 3j-ij. 

SULPHONAL OR SULFONAL. 

When was it introduced, and what are its properties ? 

This substance, chemically diethyl sulfon-dimethy -methane, was first 
brought to professional notice in 1888. It occurs in very stable crystals, 
very insoluble in ordinary solvents, and is tasteless and odorless. 

What is its principal effect? 

In medicinal doses, gr. xv to xxx in man, it produces a quiet sleep. 
Owing to its insolubility, and consequent slow absorption, its hypnotic 
effects are not produced until one half to two hours have elapsed, and 
are apt to be protracted, causing lassitude and mental confusion during 
the succeeding day. Its mode of action is not clear. There seems to 
be no cardiac or respiratory depression, and the motor and sensory nerves 
are unaffected ; hence not analgesic. Convulsions may occur in animals, 
but have not been noticed in man. 

What of its therapeutic use and administration ? 

As a pure hypnotic it is very valuable, being safer than, but not so 
certain as, chloral ; useless when pain exists. It is used in the insomnia 
of mental over-exertion or nervous excitement, of hysteria, and of 
insanity. Small doses, gr. iij to vj, often prove antiemetic. It should 
be administered in powder form, stirred up in warm milk, broths, etc., 
about one and a half hours before sleep is desired. Tablets and pills 
may escape absorption. 

AMYLENE HYDRATE. 

What is it ? What are its effects ? Its uses ? 

A colorless liquid of penetrating odor and somewhat pungent taste, 
readily miscible with alcohol in all proportions, and soluble in 8 parts of 
water; introduced in 1885. Moderate doses induce sleep without depres- 
sion of organic functions ; large doses may cause narcotic symptoms, with 
paralysis of centres in medulla. In medicinal doses, ff\,xx to xl, it is a 
safe and moderately reliable hypnotic but is inferior to chloral and 
sulphonal in activity. 



42 HYPNOTICS. 

PARALDEHYDE. 

What is paraldehyde? and how does it affect man? 

A colorless fluid at ordinary temperatures, of very penetrating odor 
and peculiarly disagreeable taste. Ordinary doses act as 2, pure hypnotic 
of rather uncertain power, requiring two or three times the amount that 
chloral does. No unpleasant effects follow, barring an offensive breath. 
Very large amounts may paralyze respiration and circulation. An ery- 
thematous eruption may follow a single dose, while its continued use may 
cause malnutrition. In doses of 3ss-j or more it is a pure hypnotic. 

URETHAN. 

What are its chemical composition and action? 

This drug, which is chemically carbamide of ethyl, occurs in crystals 
easily soluble in water and not unpleasant to the taste. Its administra- 
tion is followed in from one-quarter to three-quarters of an hour by a 
natural sleep, without unpleasant after-effects, with no depression of circu- 
lation, and possibly slight depression of respiration. It is not as certain 
in its action as chloral or sulphonal. Large amounts produce paralysis 
of respiration in animals. It does not affect the sensory nerves. 

What is its administration? 

Grr. xv to 3j by mouth or rectum. 
What are its uses ? 

As an hypnotic ; as an antispasmodic in uraemic or puerperal convul- 
sions. 

HYPNONE.— METHYLAL. 
What is hypnone ? 

Aceto-phenone ; not well known, and reports as to its efficacy are un- 
favorable. It is a colorless, volatile liquid, of characteristic odor and 
easily soluble in alcohol ; dose 3ss to 3j. 

What is methylal? 

Like hypnone, this is a very volatile liquid, but has a greater solubility, 
being dissolved by water, alcohol, and oils. It is claimed by its advocates 
to produce lowered excitability of the cerebral cortex, with decrease of 
reflex activity and a varying degree of anaesthesia, and by mouth or in- 
halation to produce sleep without either depression of circulation or 
respiration ; others, however, have found it depressing to these organic 
functions. It is quickly absorbed and eliminated, and its hypnotic effect 
is of brief duration. Patients quickly lose susceptibilit}^ to the drug, 
and its value is still sub judice. 

BELLADONNA GROUP. 
The drugs of this group present a marked similarity of action and 



BELLADONNA GROUP. 43 

uses.^ They cause marked mydriasis (dilatation of pupil) and a peculiar 
delirium ; they are antispasmodic. 

Belladonna Folia. 
Belladonna Kadix. 

What are the origin and active principles of belladonna ? 

Belladonna is the leaves and root of Atropa belladonna, or deadly 
nightshade, a plant of Europe, the whole of which contains the narcotic- 
principle ; but these parts only are officinal. Its sole active constituent is 
atrophia (atropine or atropia) ; this occurs in crystals of a bitter, burn- 
ing taste, odorless, quite soluble in alcohol and ether and in about 300 
parts of cold water. The officinal sulphate is easily soluble in water. 

What are the preparations of the leaves and roots ? 

Of the leaves : 

Tinctura Belladonnas (1 : 66), dose it\,x-3ss. 

Extractum Belladonnas Alcoholicum. dose gr. J- J. 

Unguentum Belladonnas (10 per cent of above). 
Of the root : 

Abstractum Belladonnas, twice as strong as powder, dose gr. \ to j. 

Extractum Belladonnas Fluidum, dose i*lj-ij-iv. 

Emplastrum Belladonnas. 

Linimentum Belladonnas. 

1K3K Sulphas. }doseg, T kto^. 

How does belladonna affect the nervous system? 

In general, atropine maybe considered to stimulate the sympathetic 
system, and to depress the motor, and to a less degree the sensory, nerves, 
thus diminishing the reflexes. But in therapeutic doses these effects on 
the motor and sensory nervous organs are probably slight. Sufficient 
doses excite the cerebrum, taking the form of an active, busy delirium. 
followed, if dose be toxic, by stupor, deepening into a coma, which is 
partially due to insufficient oxidation. (It is not a true hypnotic. ) Con- 
vulsions are present or absent according as the cerebral excitement or 
the peripheral paralysis predominates. 

How does it affect the circulation? 

Heart. — After a primary slowing (?) its action is increased in rapidity 
from (a) paralysis of the inhibitory fibres of the pneumogastric, and (b) 
stimulation of the cardiac sympathetic ganglia. Large doses may prove 
cardiac paralyzers. 

Vaso-motor Apparatus. — Sympathetic vaso-constrictors are stimulated 
by therapeutic doses, with a resulting increase of arterial pressure; large 
doses paralyze and the blood-pressure falls. 



44 HYPNOTICS. 

How does it affect the respiration and temperature ? 

Belladonna is one of our most potent measures for stimulation of the 
respiratory function, acting when vagi are cut — viz. by direct stimulation 
of the respiratory centre. Very large toxic doses cause paralysis in the 
same manner. The temperature also is increased by medicinal and low- 
ered by very large doses. 

How does it affect the intestinal canal? 

Peristaltic movement is said to be stimulated at first ; later it is doubt- 
less lessened by depression of the smooth muscular fibres. 

How does it affect the glandular system and secretions ? 

Secretion of salivary and muciparous glands is diminished, causing, as 
one of the earliest symptoms, a dryness of the mouth. This is due to 
depression of the terminal filaments (e. g. in the case of the submaxillary 
gland depression of the terminal filaments of the chorda tympani), with 
probably a stimulation of the sympathetic. 

Perspiration is decreased, partly, doubtless, by stimulation of sympa- 
thetic vaso- constrictors : at the same time a bright, so-called scarlatini- 
form eruption may develop, followed in some cases by desquamation. 

The effects on urinary and intestinal secretion are in doubt, though 
the urine is probably increased from diminution of perspiration, and its 
solids are said to be augmented. The drug is largely eliminated by the 
urine. 

What are its effects on the eye? 

Pupils are dilated, however the drug be exhibited, this mydriasis being 
due to paralysis of the oculo-motor nerve and stimulation of the cervical 
sympathetic. It is accompanied by loss of power of accommodation and 
diminished intraocular tension, and lasts from five to ten days. The mode 
of action is probably the same whether topically applied or administered 
internally. The sensibility of the retina is probably lessened, thus re- 
lieving the photophobia which would follow mydriasis. 

What are its local effects? 

It acts as a paralyzant of motor and sensory nerves, although probably 
not enough is absorbed through the epidermis to cause analgesia. 

What therapeutic indications does it meet ? 

Belladonna, or its equivalent atropine, is used to fulfil the following 
indications : 

(1) To relieve spasm in whooping cough x nervous cough, spasmodic 
asthma, and hiccough. It may palliate and is often used in spasm of the 
sphincter ani from fissure or other painful rectal or anal condition, and in 
urethral spasm it may be advantageously given as a suppository. 

In simple spasmodic colic, spasmodic dysmenorrhcea, and peristaltic 
spasm (as in lead colic) it is valuable. In the last-named condition, where 
the pain and constipation are due to a tetanic condition of the muscles of 



BELLADONNA GROUP. 45 

the intestinal wall, the rationale of its use is not apparent until we know 
that the splanchnics are largely cerebrospinal nerves, and are accordingly 
depressed. 

In nocturnal incontinence of urine in children, when due to relaxation 
of sphincter vesicae or to a morbid irritability of the bladder mucous 
membrane, it is often of great value ; also in nocturnal emissions* and 
as an adjunct to cathartics to prevent griping. 

(2) To diminish secretions in ptyalism, either mercurial or that of 
pregnancy ; chronic gastritis with excessive secretion ; acute coryza — sim- 
ply palliative ; colliquative diarrhoea and nightsweats — very effectual ; 
to diminish lacteal secretion — either locally as an ointment or internally. 

(3) As a stimulant in shock, where the loss of temperature is due to 
vaso-motor paralysis, it is invaluable. 

It is also employed, but with less success, in adynamic fevers : it is 
valuable in collapse occurring suddenly in the course of any acute disease, 
and as a respiratory stimulant in ether narcosis. 

(4) To relieve pain in neuralgia, especially fa cial, sciatic, and ovarian, 
it may prove satisfactory, but has its superiors. It should be injected 
into the region of the affected nerve. Locally, its effects must be slight, 
but it has found employment in pruritus vidvce, vaginismus, etc. 

(5) As an antidote to opium-poisoning it should be cautiously employed. 
(See Opium.) 

(6) In ophthalmology atropina is much used in gr. iv to Sj solutions for 
the following purposes : to dilate pupil and paralyze accommodation ; for 
thorough examination in cases of suspected astigmatism or cataract, and 
sometimes it is necessary in examinations of the fundus ; as a remedy in 
preventing adhesions of iris in iritis, and to break them up when formed, 
and in inflammatory conditions of the cornea, etc. 

What are the diagnostic symptoms and treatment of belladonna- 
poisoning ? 

The characteristic symptoms are dryness of throat, rapid breathing 
and pulse, muscular relaxation, pupils dilated — often enormously so — 
skin eruption, active delirium with or without convulsions, passing into 
sleep or coma, and complete collapse. Treat by evacuation of stomach 
by pump, syphon, or emetic; by chemical antidotes — tannic acid and solu- 
tions of the caustic alkalies ; then administer remedies to prevent circu- 
latory and respiratory failure. (See Opium. ) The physiological antidotes 
are morphine, pilocarpine, and physostigmine, but their use should be 
guided by the sj-mptoms presented. 

What is homatropine hydrobromate ? 

Atropine is resolvable into tr opine and tropic acid. Tropine salts with 

* In this condition the patient should be directed to empty his bladder and 
rectum thoroughly before retiring to relieve all prostatic pressure, to abstain 
from fluid during evening, to lie upon the side, and should be encouraged for 
moral effect. 



46 HYPNOTICS. 

hydrochloric acid form tropcins. Homatropine is a tropein derived in 
this manner from amygdalate of tropine. It is chiefly employed as a 
mydriatic. Its effects are similar to those of atropine, but are more 
quickly developed and pass away much more rapidly. This fact and 
its non-irritating nature render it very practical. 

STRAMONIUM. 

What are the botany and chemistry of stramonium ? 

Folia and Semen. — Leaves and seeds of Datura Stramonium. James- 
town weed. Its active principle is daturint. probably a mixture of atro- 
pine and hyoscyamine. 

What are the preparations of stramonium ? 

There are no official preparations of the leaves, but they are dried and 
used for smoking. Of the seed we have — 

Extractum Stramonii. dose gr. }-J. 

Extractum Stramonii Eluidum. dose rnj-iij. 

Tincture Stramonii. dose ntx-oss. 

Unguent um Stramonii [10 per cent, of extract). 

How does it differ from belladonna ? 

The physiological and toxic effects of stramonium correspond so closely 
to those of belladonna that no separate consideration is needed. Owing 
to the common occurrence of the weed, poisoning is rather more fre- 
quent. Treat as for belladonna-poisoning. 

Has it any special advantages? 

From its physiological effects the uses may correspond closely to those 
of belladonna, but it is not commonly employed. Often used as cigar- 
ette in asthma. 

HYOSCYAMUS. 

What are its botanical and chemical properties? 

Hyoscyamus is the leaves of Hyoscyamus nigra (henbane), a European 
plant : plants should be of the second year's growth. It contains two 
alkaloids — the one hyoscyamine^ crystalline, isomeric with atropine, and 
having an officinal sulphate U. S. P.) ; the other hfoscinc. amorphous. 
isomeric with atropine and hyoscyamine. but differing from them in 
physiological effects. The latter forms crystallizable salts, and is most 
used as the hydrobromate, 

What are the preparations of hyoscyamus ? 
Hyoscyami Pulvis. dose gr. v-x. 
Abstract um Hyoscyami. dose gr. ij-iij- 

Extractum Hyoscyami Alcoholicum, much used, dose gr. J— ij. 
Extractum Hyoscyami Fluidum. dose n\,y-x. 



DUBOISIA. — AGARICIN. 47 

Tinctura Hyoscyami (16 per cent.), most used, dose 3ss-ij. 

Hyoscyaminae Sulphas, dose gr. xi^~^- 

Hyoscine Hydrobromate, not officinal in 1880, dose gr. 



i i 

What physiological effects does it produce ? 

The physiological effects of hyoscyamus are very analogous to those 
of belladonna, hyoscyamine being nearly identical with atropine. Hyos- 
cyamus differs in being less energetic, less persistent in its action , and more 
hypnotic. 

Hyoscine. — This alkaloid has recently been studied, and seems to be 
the hypnotic principle of hyoscyamus. In addition to the ordinary 
symptoms produced by drugs of this group, it has a marked depressing 
effect on the cerebral cortex and the motor tract of the spinal cord, and, 
unlike them, it is a respiratory depressant (Wood). 

What are the symptoms and treatment of hyoscyamus-poisoning ? 
The same as those of Belladonna, which see. 

What indications does hyoscyamus meet? 

The preparations of hyoscyamus may be employed to fulfil the same 
indications as belladonna — viz. antispasmodic, slightly analgesic, to 
diminish secretions, etc. As a respiratory stimulant it is inferior to its 
companion drug. 

Hyoscine hydrobromate is employed as an hypnotic in sleeplessness 
with great mental excitement, as in mania, insanity, and delirium tre- 
mens. It is said to be safe in advanced kidney disease when morphine 
is inadmissible ; also valuable in nymphomania, spermatorrhoea, and 
sexual excitement generally (Wood). It is devoid of the unpleasant 
after-effects of opium, and may be given in doses of gr. yJo to 
^ by mouth or^xtro to ^ hypodermically. Some persons show a 
decided susceptibility to this alkaloid, and doses within these limits 
have caused alarming symptoms, but no fatal cases are reported. Order 
Merck's preparation, as others are often incompletely separated from 
hyoscyamine. 

DUBOISIA. 

This drug, which is unofficinal, contains duboisine, probably identical 
with hyosc} T amine, and its effects and uses are those of other herbs of 
this group. It is derived from Duboisia myoporoides (Nat. Ord. Sola- 
nacece), and is a native of Australia. 

AGARICIN. 
What is it ? 

A preparation of agaricus or larch fungus. Its mode of action is 
unknown. It is successful in colliquative sweating and excessive bron- 
chial secretion, and may therefore be considered in this connection. 



48 SPINANTS. 

ERYTHROXYLON COCA. 

Whence is it derived ? What does it contain ? 

This drug is the leaves of Erytkroxylon coca, a South American plant. 
It contains cocaine, the local anaesthetic effects of which have already 
been considered, and hygrine, a mydriatic principle. 

Extractum Erythroxyli Fluidum is officinal, dose fl\,xx to 5j- 

What are its physiological effects? 

Nervous System. — A sense of exhilaration and stimulation of the 
mental faculties, followed by restlessness or "nervousness," is produced; 
loss of desire for sleep and lessened sense of fatigue ; reflexes are at first 
increased, but later diminished, probably from paralysis of afferent and 
efferent nerve-fibres both peripherally and in the cord. _ Later, after large 
doses, delirium, inco-ordination of movement, convulsions, paralysis, and 
anaesthesia may ensue. 

Circulation. — The heart's action is rendered more rapid by depression 
of the cardio-inhibitory fibres of the vagus, and a consequent increase 
of blood-pressure follows. Large doses depress the circulation. 

Respiration is at first powerfully stimulated, but later, after large 
doses, is depressed, and toxic doses destroy life by paralysis of this func- 
tion : these effects are centric, occurring when vagi have been divided. 
Coca increases heat-production and the body-temperature is raised. 

Secretions. — Cocaine is eliminated in the urine, which may be in- 
creased ; the skin may be moist : neither of these effects is constant. 

Eye. — Pupil primarily slightly contracted, later widely dilated, by its 
local application ; the intraocular tension is lowered and accommodation 
paralyzed, but to a less extent than by atropine. 

What are the symptoms and treatment of the cocaine habit ? 

The symptoms are digestive disturbances, insomnia, emaciation, 
general enfeeblement of body and intellect, with tremors and loss of 
co-ordinate movement. Withdraw the drug. Acute poisoning may 
occur: the symptoms are restlessness and excitement, rapid breathing 
and muscular twitchings ; later, collapse, slow and labored respiration, 
largely-dilated pupils, epileptiform convulsions, loss of consciousness, 
delusions, mania, etc. The smallest fatal dose is not certain. Respir- 
atory stimulants are indicated. 

What is the therapy of cocaine ? 

Coca is a nervous tonic, and may do good in melancholia, neurasthenia, 
etc. It will often relieve gastralgia and the pain of gastric ulcer, and 
check vomiting. Locally applied, it contracts the nasal blood-vessels. 

SPINANTS. 

Spinants are drugs tending to excite muscular contraction o\ motor 
paralysis, and may be divided into excito-motor and dejyresso-motors. 



NUX VOMICA. 49 

EXCITO-MOTORS. 

As far as ordinary muscles go, the drugs so considered are those con- 
taining strychnine and brucine. Ergot and digitalis act similarly on par- 
ticular organs, the uterus and heart. 

NUX VOMICA. 

What are its origin and active principles? 

Nux vomica is the seeds of Strychnos nux vomica, an East Indian 
tree. It contains two alkaloids — strychnine and brucine — in combination 
with igasuric acid. Strj'chnine represents fully the activity of its parent 
drug ; brucine being similar, but weaker, in its action. 

Name the preparations of nux vomica. 

Abstractum Nucis Vomicae, dose gr. j-ij. 
Extractum Nucis Vomicae, dose gr. i-j. 
Extractum Nucis Vomicse Fluidum, dose NUj-v. 
Tinctura Nucis Vomicae (1 : 5), dose n\,v-xv. 
Strychnina, ) i i i 

.QfTMrnhr^o* SnlrOiaa I Q0Se S P ' 60 20' 



Strychninae Sulphas, 

) 
What are the properties of strychnine ? , 

Strychnine is a white powder, crystallizing from its solutions, odorless, 
superlatively bitter, very insoluble in water, but freely so in alcohol, and 
present in from J to i per cent, in the crude drug. Its sulphate is solu- 
ble in water, but its solutions are seldoni used medicinally, because of 
their intense bitterness. It yields a violet color with oxidizing agents, 
and this is the basis of several tests for the drug, but the physiological 
test is more reliable. The latter consists in injecting some of the sus- 
pected solution into a frog or other small animal, and noting if physio- 
logical effects are produced. 

What are its physiological effects? 

Nervous System. — The cerebrum is unaffected and consciousness is 
unimpaired, except in the last stages of poisoning, when its loss is due 
to imperfect oxidation. Strychnine exerts a selective action on the motor 
cells in the anterior cornua, the reflex function being exaggerated. In 
poisoning, the motor nerves are depressed, partly from exhaustion and 
partly from a direct action on their fibres (?). The sensory nerves are 
little affected. 

Circulation. — Heart-action accelerated and arterial tension increased 
by medicinal, and depressed by toxic doses. 

The respiration is greatly stimulated. Death may result from a tetanic 
condition of the respiratory muscles, resulting in asphyxia, or more rarely 
from exhaustion. 

Special Senses. — Vision and hearing are rendered more acute ; tinni- 
tus aurium may occur ; the pupils are somewhat dilated. 
4— M. M. 



50 SPINANTS. 

Digestion. — From its bitter taste it excites the secretions of the gastro- 
intestinal tract, increasing the appetite and promoting digestion. It 
increases peristaltic action. 

What are the diagnosis and treatment of strychnine-poisoning ? 

Strychnine maybe used with criminal intent, and gr. ss has proved 
fatal to an adult. The symptoms of poisoning are as follows in their 
order of development : sense of uneasiness, jerky respiration, stiffness 
of inferior maxilla, and shuddering ; these are suddenly succeeded by 
tonic convulsions, especially of extensors, causing risus sardonicus, opis- 
thotonos, etc. ; pallor, succeeded by cyanosis from respiratory embarrass- 
ment. These spasms succeed one another on the slightest peripheral 
irritation, and, if to prove fatal, cause death in a few hours either by 
asphyxia or exhaustion. Very large doses may cause death quickly and 
almost without symptoms, apparently by a profound impression on the 
centres of organic life. 

Diagnosis. — Traumatic tetanus is the main condition from which its 
toxic effects are to be diagnosticated. The following points of difference 
may be tabulated : 

Strychnine Tetanus. Traumatic Tetanus. 

(1) Duration short. Duration longer. 

(2) Development sudden. Gradual. 

(3) Extremities first involved. Face first (trismus). 

(4) Intermission and muscular re- Less marked ; spasm almost con- 

laxation more marked. stant, especially trismus. 

(5) Swallowing possible. Impossible. 

Treatment consists in (1) eliminating the poison, (2) checking the con- 
vulsions, and (3) maintaining respiration. The drug remaining in the 
stomach may be rendered partially insoluble by tannin, after which the 
stomach is emptied by emetics or the stomach-pump. The spasms may 
be averted by the joint use of chloral and bromides, but if already pres- 
ent the temporary use of ether, or even chloroform, may be necessary 
until these produce effects. Artificial or forced inspiration is to be 
employed if cyanosis develop. 

Of what therapeutic use is strychnine ? 

Strychnine is used (1) in gastro-intestinal disorders as a stomachic 
tonic in anorexia, chronic gastritis, and atonic dyspepsia, in which con- 
ditions it should be given before meals; in morning nausea and the vom- 
iting of pregnancy and alcoholism, which may be relieved; in functional 
disorder of the liver with intestinal indigestion, and as a tonic in cirrho- 
sis ; in constipation from inactivity of the muscular coat. 

(2) In hsemic disorders, as anaemia, chlorosis, hemorrhagic diathesis, 
purpura, etc. , it may prove a good indirect tonic. 

(3) In relaxed conditions of the genito-urinary system, as in impo- 
tence, nocturnal emissions, incontinence of urine, etc. , when atonic or 



IGNATIA. — COCCULUS INDICUS. 51 

functional and not dependent on organic defect ; also in amenorrhoea and 
neuralgic dysmenorrhoea it is occasionally used. 

(4) In paralyses, especially those of peripheral origin, as lead-palsy 
and peripheral neuritis, it is often of great value, and is best adminis- 
tered hypodermically in the affected region. It is of less value, but 
may do good, when the paralysis is of centric origin, but is positively 
contraindicated during the early or rigid stages or when any acute pro- 
cess obtains. Amaurosis due to alcohol or tobacco, and amblyopia from 
disuse, as is seen in strabismus, may be cured by strychnine. In all 
paralyses the drug must be pushed to the production of slight physio- 
logical effects. Given hypodermically or in enemata, by stimulating 
respiration and circulation it is of great value in surgical shock and in 
asthenic conditions generally. It is partially antidotal to opium and 
chloral. In the dyspnoea of cardiac disease it is an efficient adjuvant to 
digitalis. Petit mal may be benefited by strychnine. 

How may it be administered? 

Strychnine is generally given in pill form, except when large doses are 
required, when solutions should be employed to avoid any inaccuracy of 
dosage. It should not be given in the same solution with tannic acid, 
nor should it be combined with bromides, chlorides, or iodides, which pre- 
cipitate it partially from its solutions. Such combinations might cause 
the last portion to contain an over-dose. It is very readily absorbed by 
the rectum, and the rectal dose should be the same as by mouth. 

How does brucine differ from its sister alkaloid ? 

Recent experiments seem to show that this alkaloid differs from 
strychnine in having a greater effect on the sensory nerves, being some- 
what anaesthetic in strong solutions. It has little effect when taken by 
mouth, owing to its rapid elimination. 

IG-NATIA. 

Ignatia is the seeds of Strychnos Ignatia. It contains the same active 
alkaloids as nux vomica, the strychnine being present in larger propor- 
tions {i per cent, or more). Its preparations are — 

Abstractum Ignatiae, dose gr. ss-j. 

Tinctura Ignatiae, dose TtLx-xx. 

Its action and uses, consequently, are those of nux vomica. 

COCCULUS INDICUS (PICROTOXIN). 

What is its origin? its active principle? 

Cocculus Indicus is the dried berries of Anamirta paniculata, an East 
Indian shrub. It owes its activity to a neutral principle, picrotoxin, 
which is a white, crystalline, bitter substance somewhat soluble in water 
and freely so in alcohol and ether. Not being an alkaloid, it is not pre- 



52 SPINANTS. 

cipitated by substances containing tannic acid. It is officinal as picrotox- 
inum. 

What are its effects and uses? 

Like strychnine, it is a tetanizing agent, having a selective action on 
the centres in the medulla (Biddle), and causes death in large doses by 
tetanic fixation of the respiratory muscles. It produces decided diapho- 
resis. It is chiefly used locally as a decoction or ointment for the destruc- 
tion of lice and the parasite of tinea versicolor. Lately it has been used 
in doses of gr. T fo to -^ for the night-sweats of phthisis. Otherwise it 
is little used internally. 

Ergot and Digitalis, although muscular excitants, will be more prop- 
erly considered elsewhere. 

DEPRESSO- MOTORS. 
PHYSOSTIGMA (CALABAR BEAN). 

What are its origin and alkaloids? 

Physostigma is the kidney-shaped seeds of the Physostigma venenosum, 
or ordeal bean of Calabar. These contain as their active principle an 
alkaloid, physostigmine or eserine. Calabarine and other alkaloids have 
been isolated, but are probably decomposition-products of eserine. Cal- 
abarine is believed to be a tetanizing agent. Eserine is sparingly soluble 
in water, but its officinal salt, the salicylate, dissolves in 130 parts of 
water. 

What preparations of physostigma are officinal? 

Tinctura Physostigmatis, dose fflv-xx. 
Physostigminae Salicylas^dose gr. iJo-bV 
Extractum Physostigmatis, dose gr. Jo~i. 

What physiological effects does it produce? 

The S3 T mptoms produced by full doses are giddiness, pallor and coolness 
of the skin, contracted pupils, muscular relaxation, weakness, and drow- 
siness, but no stupor ; vomiting and purging may occur. Toxic doses 
add to these effects symptoms of respiratory embarrassment and a total 
loss of reflexes. 

Nervous System. — The cerebrum is unaffected even by large doses, but 
the centres in the gray matter of the spinal cord are depressed, causing 
diminution or complete loss of reflexes. Depression of the motor and 
sensory nerves occurs only in large doses, that of the former to a greater 
degree. This effect is due, it is supposed, to an action on the peripheral 
end-organs. 

Circulation. — Small doses slow the pulse-rate, rendering the diastole 
of the cardiac cycle longer. Toxic doses may arrest the heart in diastole, 
but the heart generally continues to beat after respiration fails. This 



CURARE OR WOORARA. 53 

slowing is not due to stimulation of the vagi, as it occurs when they have 
been divided, but is probably the result of a direct depression of the 
intracardiac nervo-muscular apparatus (the heart-muscle and its contained 
ganglia) : this, however, has not been positively proven to be its mode 
of action. The arterial tension is at first raised, but by toxic doses is 
finally lowered. 

Respiration is depressed, and in fatal cases death takes place from 
respiratory paralysis. 

Intestines. — Peristalsis is decidedly increased, a tetanic condition being- 
produced by large doses : this is followed by relaxation from over-stimu- 
lation and exhaustion. 

Eye. — The pupil is strongly contracted, probably by local influence — 
?'. e. by paralysis of the sympathetic terminals and oculo-motor stimula- 
tion. Thus it antagonizes the effects of atropine. This myosis is not 
constant, and is not of so long duration as the mydriasis of atropia. The 
ciliary muscle is stimulated, the drug thus acting again in antagonism to 
atropine as regards power of accommodation. 

What are the symptoms of toxic doses ? 

The prominent symptoms and signs are contracted pupils, embarrassed 
respiration, muscular weakness, and abolition of reflexes. Severe symp- 
toms have been recovered from. 

What is the treatment of physostigma-poisoning ? 

Atropine tentatively is the proper antidote. Measures against shock, 
as artificial warmth, etc. and artificial respiration, are to be employed as 
necessity arises. 

What are the uses of physostigma therapeutically ? 

Internally, it may be used with success in tetanus, strych nine-poisoning, 
and convulsive conditions generally. With a good preparation of the 
alkaloid it will prove one of the best measures against tetanus. In chorea 
and bronchial catarrh with dyspnoea it has its advocates. In ophthal- 
mology it is used to antagonize atropine or to alternate with it in tearing 
up adhesions, etc. 

CURARE OR "WOORARA. 

What is curare? 

Curare is an unoflicinal drug of uncertain origin, being derived from 
different varieties of Stryclmos, but containing no tetanizing principle. 
It contains an alkaloid, curarine, the dose of which will be gr. y^ to -^ 
or even larger by mouth, or ^io to rio hypoderniically. The dose of the 
crude drug is -^ to J of a grain. 

What is its action? 

Curare is comparatively innocuous by mouth. Hypoderniically, its 
only action is to paralyze the terminal motor -filaments, with of course an 



54 SPINANTS. 

incidental diminution of the reflexes, the muscular fibres and sensory 
nerves preserving their irritability. Death is caused by paralysis of the 
respiratory muscles. 

What are its uses? 

Although it is chiefly used in physiological experimentation, it has 
been used in tetanus, hydrophobia, strychnine-poisoning, and muscular 
cramps and spasms. In all these conditions it can only be of use by 
lessening the exhaustion dependent upon the spasms. 

CONIUM. 

What is conium ? and what is its active principle ? 

Conium is the fruit of Conium maculatum, or hemlock, a plant of 
Europe. Its active principle is conine, a transparent oily fluid of bitter 
taste and a peculiar mouse-like odor. Conine is one of the volatile alka- 
loids (the others being lobeline (?), nicotine, and sparteine), and is thus 
unstable, which instability and its presence in varying proportions in 
the plant render it an uncertain and perhaps unsafe remedy. 

What preparations of conium are in use ? 

Abstractum Conii, dose gr. }-vj. 

Extractum Conii Alcoholicum, dose gr. J-iij. 

Tinctura Conii (1 : 66), dose 3ss-j. 

Extractum Conii Fluidum, in which the conine is fixed by hydrochloric 
acid, is the best preparation, in doses of tt\j-xv. 

Squibbs' Fluid Extract of Conium is a good preparation, the com- 
mencing dose being tt\,x, to be increased until effects are produced. 

In fact, whatever preparation is used it is safer to begin with the 
minimum dose and increase it in this way. Of conine itself the dose is 

Give the physiological effects of conium. 

The symptoms produced are weakness and heaviness of extremities, 
beginning in the legs, disordered vision, and giddiness. Large doses 
cause respiratory failure. 

Nervous ^ System. — The cerebral hemispheres are unaffected except by 
the asphyxia of the poisoning ; its characteristic effect is paralysis of motor 
nerves, affecting first their end-organs, the muscles retaining their irrita- 
bility after death. Sensation and the spinal reflex centres are perhaps 
slightly affected by large doses. The pupils are dilated, but not con- 
stantly so. 

Respiration. — The respiratory centre is not affected, but the muscles 
of respiration are paralyzed, thus causing death. The circulation is very 
little if at all affected. The temperature is slightly reduced. Elimina- 
tion takes place by the urine, and the secretions are only slightly affected 
by the drug. 



GELSEMIOI. 55 

What are the toxicology and treatment of conium ? 

Toxic doses produce nausea, vertigo, ocular disturbances, as ptosis, 
diplopia, and dilated pupils, muscular, and respiratory paralysis, coma, 
convulsions, and death. The treatment consists of cardiac and respi- 
ratory stimulation, especially artificial respiration, external warmth, etc. 

What is the therapeutic indication for conium? 

Conium is used medicinally to fulfil only one indication, that of di- 
minishing muscular excitability. For this purpose it maybe, but seldom 
is. used in chorea, local spasms (as blepharospasm), acute mania with 
great motor excitement, and in tetanus {?). In all these conditions it 
must be pushed to the production of its physiological effects. 

GELSEMITJM. 

What are its derivation and active principle ? 

G-elsemium is the rhizome and rootlets of Gelsemium sempem'rens, the 
yellow or Carolina jasmine. Its preparations should be made from the 
fresh root, as its alkoloid. gelsemine. which exists in combination with a 
glucoside, gelseminic acid, disappears on drying. 

What preparations are officinal ? and which is most used ? 

Tinctura Gelsemii. 15 per cent., dose ^Ix-xx or more. 

Extractum Gelsemii Fluidum, dose tt\,v-xv. 

The latter is the favorite preparation. A drachm of it has caused 
serious symptoms, and two teaspoonsful death. 

What are its effects in varying doses ? 

Small amounts produce few symptoms or none ; medicinal doses cause 
languor, muscular fatigue, dizziness, ocular disturbances, and frontal 
headache ; large doses are followed quickly by an exaggeration of these 
symptoms, with strongly dilated -pupils, diplopia, ptosis, and sometimes 
internal strabismus, falling of jaw, weakness of pulse, and lessened respi- 
ration. Toxic doses add to these effects the following : inco-ordinate 
movements, coldness of surface, and unconsciousness, followed by death 
from paralysis of respiration. 

Nervous System. — The cerebrum is unaffected. The motor tract of 
the spinal cord is paralyzed, this paralysis being at times preceded by a 
period of spinal excitability with convulsions. The depression of respi- 
ration is due either to an effect on the respirator}' centre (Wood) or on the 
respiratory muscles (Bartholow). The ocular symptoms noted above are 
due to paralysis of the peripheral endings of the oculo-motor and ab- 
ducens nerves respectively. 

What therapeutic uses does it fulfil? 

This drug may be used with success in spasmodic conditions, as tetanus, 
spasmodic and hysterical cough, laryngismus stridulus, and asthma ; in 



56 SPINA NTS. 

neuralgias, especiallly in the facial and ovarian types ; in the early 
stages of pneumonia and 'pleurisy \ in which condition it does good by 
lessening the frequency of the inspiration and depressing the general 
circulation, thus lessening the liability to pulmonary stasis (Bartholow). 

What is its toxicology ? 

Cases of poisoning are to be treated by cardiac and respiratory stimu- 
lants. In administering the drug give it until muscular weakness, slight 
ptosis, or double vision is complained of. 

We come now to a brief consideration of two closely-allied drugs, 
whose therapeutic importance is very slight, and whose chief claim to 
interest lies in their physiological effects — tobacco and lobelia. 

LOBELIA. 

From what does it come ? What is its active principle ? 

Lobelia is the leaves and tops of Lobelia inftata, or ' ' Indian tobacco. 
Its sole active principle is lobeline, once thought to be a liquid alkaloid, 
but which has been shown by more recent investigation to be a colorless, 
odorless, crystalline substance. 

What are the preparations of lobelia ? 

Extractum Lobeliae Fluidum, dose w\j-v. 
Acetum Lobeliae (10 per cent.), dose tt^x-^ss. 
Tinctura Lobeliae (20 per cent.), dose tflx-xx. 

What effects does it produce? 

Lobelia produces, in large doses, burning of fauces, oesophagus, and 
stomach; vomiting, purging, and other symptoms of gastro-intestinal 
irritation; slow pulse, cold sweating, and profound muscular depression. 
Toxic doses add to these effects collapse, stupor, coma, and death, which 
is at times preceded by convulsions. The muscular paralysis and respir- 
atory depression are spinal in origin, while the vomiting is probably due 
both to local and centric action. 

Has it any uses ? 

Its uses are few, the chief being in asthma due to spasm of bronchi as 
an antispasmodic. An infusion (§j to Oj) is recommended in the erup- 
tion produced by poison ivy, as a local application. As an emetic it is 
far too harsh, and is no longer used. 

What is its toxicology ? 

For symptoms of poisoning see above. The treatment consists in 
copious draughts of warm solutions of tannic acid, its antidote, with stim- 
ulation by alcohol and ammonia. 



TABACUM. — AMYL NITRIS. 57 

TABAOUM (TOBACCO). 
What is tobacco? 

Tobacco is the dried leaves of Nieotiana tabacum, an indigenous plant. 
Its active principle is nicotine, a volatile, liquid, and very potent alkaloid, 
colorless, transparent, and having the odor of tobacco. It is freely soluble 
in water. When tobacco is burned, nicotine does not appear in the 
smoke, pyridine and collodin being formed. It is said that collodin is 
less active, and is present in greater amounts in cigar smoke, while in 
that from pipes pyridine preponderates. 

Are there any preparations? 

Tabacum alone is officinal. Extemporaneous infusions, decoctions, and 
wines may be used. 

What are its effects? 

Like lobelia, tobacco is a nauseant, depressant, and an antispasmodic. 
The symptoms of the two drugs correspond closely, but a greater tolera- 
tion for tobacco can be acquired. It increases the secretions of the sal- 
ivary and intestinal glands, of the kidneys, and of the skin. It slows 
and depresses the heart and lowers the arterial tension. Death is due to 
respiratory, and occasionally to cardiac, failure. Its continued use by 
smokers often leads to^ chronic pharyngitis, gastric disorder, nervous 
depression, amaurosis either functional or due to retinal atrophy, and 
"irritable heart." These effects are especially marked in the young, 
and even mental deterioration seems to follow its use. Nicotine itself is 
a very rapid poison, dea.h having resulted almost immediately from a 
toxic dose. The indications in poisoning are the same as for lobelia. 

What are the uses of tobacco ? 

Although its use is not to be recommended on account of the danger 
entailed, it has been employed as a 'depressant antispasmodic in asthma, 
tetanus, strychnine-poisoning, and intestinal obstruction. Locally, it has 
been used in infusion or decoction as a parasiticide, but is dangerous and 
has caused death. Smoking, when indulged in moderately, seems in 
some to stimulate, in others to quiet, mental activity. 

NITRITE GROUP. 

We come now to a group of drugs acting in a dominant way upon the 
spinal cord, and circulation. It includes amyl nitrite, the nitrites of 
sodium and potassium, and nitro-glycerin, the last being chemically a 
nitrate, but probably converted into a nitrite in the blood. 

AMYL NITRIS (AMYL NITRITE). 

What are its physical properties and method of preparation ? 
Nitrite of amyl is a pale-yellow, oily liquid, of very great volatility, a 



58 NITRITE GROUP. 

banana-like odor, aromatic taste, and neutral or slightly acid reaction. It 
is formed by the reaction of amylic alcohol (fusel oil) and nitric acid. 

What effects does it produce ? 

The effects of this drug are typical of those of the group. Inhaled 
in moderate amounts, it is very quickly absorbed and produces almost 
immediately the following peculiar train of symptoms : a sense of ful- 
ness, distension, and pain in the head, flushing of face, rapid heart- 
action, violent palpitation, and labored respiration. The pulse becomes 
full and very soft. Xanthopsia (a yellow coloring of things seen) may 
occur. These symptoms pass away in a few minutes. Toxic doses cause 
pallor of the skin, muscular relaxation, irregular respiration, and death 
by asphyxia. Although generally administered by inhalation, it is readily 
absorbed by all channels except the skin. The effects seriatim are as 
follows : 

Circulation, — The heart is stimulated, its rate being greatly increased 
and its individual beats strengthened, but after toxic doses cardiac paraly- 
sis ensues. The blood-pressure is notably diminished from vaso-motor 
paralysis, principally by a direct action on the muscular coat of the vessel 
wall. The cardiac effects are due to (I) a probable initial stimulation of 
the nervo -muscular apparatus of the heart ; (2) paralysis of the vagus ; 
and (3) the sudden relief from the resistance in front. 

Nervous System. — Motor paralysis and loss of reflexes occur, due to 
depression of the motor part of the spinal cord. It is not anaesthetic. 

Blood. — The haemoglobin of the blood is converted into a substance, 
probably methsemoglobin, but this action is only partial. The color of 
arterial blood approaches that of venous, and in poisoning both become 
chocolate-colored. Owing to this lessened oxidizing power of the blood 
the temperature is depressed. 

What are the therapeutic uses of amyl nitrite? 

It is used as an antispasmodic in the following conditions : 

In angina pectoris, in which, by overcoming the accompanying increase 
of arterial tension, it gives marked and immediate relief whatever may 
be the causative condition. 

In asthma, the attacks of which may generally be relieved, especially 
when of purely bronchial type with no underlying cardiac or emphyse- 
matous condition. 

Epilepsy. — In cases in which an aura precedes, giving an opportunity 
for its administration, it will abort the attack ; in the constantly recur- 
ring spasms of the status epilepticus it is invaluable, theoretically, by 
lessening the arterial spasm of the motor area which is supposed to cause 
the convulsion. The " nitrite-of-amyl pearls" are very convenient for 
this purpose. They are delicate glass capsules containing the drug, and 
may be carried by the patient, broken on his handkerchief, and inhaled. 

In spasmodic conditions generally, as in tetanus, strychnine-poisoning, 
puerperal convulsions, uraemia, etc. , it may prove valuable. 



NITROGLYCERIN.— SODII NITRIS. 59 

In the heightened arterial pressure of renal disease it is used, but 
nitro-glycerin is preferable from the longer duration of its effects. 

In migraine, when due to arterial spasm, and in nervous dysmenorrhoea, 
it may prove palliative. 

It is also used as a cardiac stimulant in sudden syncope, profuse 
hemorrhage, and the cardiac failure of chloroform narcosis, but care 
should be exercised not to increase the existing cardiac depression by 
too large a dose ; dose, wtij-v, by mouth or inhaled. 

NITRO-GLYCERIN (GLONOIN). 

How is nitro-glycerin formed? How used? What are its prop- 
erties ? 

Nitro-glycerin (also called trinitro-glycerin) is a colorless, oily liquid, 
of a specific gravity of 1.600, formed by the action of nitric and sulphuric 
acids on glycerin. It is a violent explosive, and is generally used in 
medicine in a 1 per cent, alcoholic solution, known as glonoin, the dose 
of which is gtt. ss to iij. Efficient tablet triturates are also much used. 

What are its physiological effects? 

Nitro-glycerin acts upon the circulation, blood-pigments, spinal cord, 
and muscles as does amyl nitrite, but differs in its slower action, less vaso- 
motor depression, and greater tendency to produce headaches. It takes 
effect in from five to ten minutes, and these effects are not protracted 
beyond an hour, so that in order to maintain a constant effect it must be 
frequently repeated. 

What are its uses? 

Its uses are those of Amyl Nitrite (which see), with the exception, 
of course, of epilepsy, in which the volatility of the latter gives it the 
preference, (xlonoin is much better when it is desirable to maintain a 
steady reduction of arterial tension. 

POTASSII NITRIS (POTASSIUM NITRITE). 
SODII NITRIS (SODIUM NITRITE). 

What other drugs have similar effects? 

The nitrites of potassium and sodium. These salts are crystalline, 
deliquescent, and freely soluble in water, in which last respect they have 
the advantage of nitro-glycerin, to which they are closely analogous in 
their effects. They are liable to contamination by nitrates, and are said 
to produce disagreeable eructations. Their uses would correspond to the 
above drug ; dose gr. ij-iij. 

CARDIAC STIMULANTS. 

Cardiac stimulants are drugs which are used to promote the force 



60 CARDIAC STIMULANTS. 

of the circulation. No general rule for their method of action can be 
laid down. 

AMMONIA. 
What is ammonia ? 

Ammonia is a colorless, very irritant gas, very alkaline, and very sol- 
uble in water. It is obtained as a waste product in the manufacture of 
coal-gas. It enjoys a wide range of therapeutic uses, but may be best 
considered under this heading. 

What effects has it physiologically? 

Locally, solutions of ammonia act as powerful irritants, causing pain- 
ful vesication of the skin and mucous membranes. Inhaled, ammonia 
causes irritation and inflammation of the air-passages. Swallowed in 
strong solutions, it produces vomiting, epigastric pain, bloody diarrhoea, 
and other symptoms of g astro-intestinal irritation, with at times convul- 
sions of spinal origin. Death may rapidly ensue from oedema of the 
glottis, or long afterward from pyloric stricture or other resulting struc- 
tural changes. 

Circulation. — To this function ammonia is a rapid, diffusible stimu- 
lant, increasing the heart-action by stimulation of the cardiac accelera- 
tors : it also increases the blood- pressure, not by stimulation of the gen- 
eral vaso-motor system, for it occurs after spinal section, but perhaps by 
a direct action on the peripheral nervo-muscular structures. 

The respiration is accelerated by direct stimulation of the respiratory 
centre. The secretion of the bronchial mucous membrane is increased, 
and, indeed, the drug appears to exert a selective action on mucous mem- 
branes generally. It is not an hepatic stimulant. Ammonia is readily 
absorbed, however administered, and exists as such in the blood. It is 
quickly oxidized, and is eliminated by the urine as nitric acid and urea,, 
thus giving the urine an acid reaction when ammonia itself or its tar- 
trate, carbonate, or chloride is administered. 

What are its preparations, and their characteristic features ? 

Aqua Ammoniae Fortior (28 per cent, ammonia), external use only: a 
powerful corrosive poison. See Toxicology. 

f&fTZS^^rpeTSt.), } well diluted, dose ^-^s, 

Spiritus Ammoniae Aromaticus (contains amnion, carbonat., 4 per 
cent. ; aq. ammoniae, 10 per cent. ; flavored with the oils of lavender, 
allspice, and lemon), a favorite and agreeable antacid, stomachic, and 
stimulant; dose 3ss-j. 

Linimentum Ammoniae (aq. amnion., 30 per cent. ; ol. gossip, semin., 
70 per cent.). 

Liquor Ammonii Acetatis (spirit of Mindererus) contains 7 i per cent, 
of the salt, and is used principally as vehicle ; dose ^ss-ij. 

Ammonii Carbonas (sal volatile), dose gr. v-x. 



ALCOHOL. 61 

Ammonii Chloridum (muriate of ammonia or sal ammoniac) ; has an 
officinal troche, gr. ij in each ; dose gr. v-x. 

Ammonii Phosphas, dose gr. x-xxx. 

The nitrate and sulphate are officinal for pharmacopoeial purposes only, 
while the benzoate, bromide, iodide, and valerianate produce the effects 
of the other constituents, and are not properly treated of here. All are 
officinal. 

What therapeutic value has ammonia ? 

It is used — 

As a cardiac stimulant in syncope from cardiac disease or hemorrhage, 
in chloroform narcosis, surgical shock, snake-bites, or hydrocyanic poison- 
ing, or in cardiac failure occurring in infectious diseases; its action is 
very evanescent, and frequent repetition is necessary. For inhalation 
the spirit, and for mouth or hypodermic use the aqua, are preferred. 

As a blennorrhetic expectorant in acute bronchitis or pneumonia after 
the subsidence of the acute stage (carbonate preferred), and in chronic 
bronchitis with profuse expectoration (chloride). 

In hepatic disorders, whether functional or due to structural changes, 
as beginning fatty and cirrhotic liver, catarrh of the bile-ducts, etc. , the 
chloride is efficacious, its modus operandi being, however, not clear. 

In acute exanthemata with circulatory depression and high tempera- 
ture the liquor amnion, acetatis is much used as a mild febrifuge and 
stimulant. 

In catarrhal conditions of the stomach or intestines the chloride does 
good, but the continued use of this-or any other alkali is not advisable. 

In gastric acidity with vomiting and headache the carbonate in solu- 
tion in liq. amnion, acetat is a valuable remedy ; also in combating the 
after-effects of acute alcoholism. 

In cystitis the ammonia salts above mentioned are useful, and the ben- 
zoate is particularly valuable by acidifying the urine and disinfecting the 
mucous membrane of the bladder. 

Ammonia-poisoning and its treatment. 

Poisoning may occur by the ingestion of the stronger ammonia-water. 
The symptoms are those of corrosive poisoning, and have already been 
mentioned. The treatment consists in the administration of dilute acids, 
as vinegar, lemon-juice, etc. 

ALCOHOL. 

What is an alcohol ? What is alcohol ? How obtained ? 

An alcohol is an organic compound, the hydrate of some one of the 
methyl series. (Thus, methyl hydrate, CH 3 OH, is methyl alcohol or 
fusel oil; C 2 H 5 OH is ethyl hydrate or ethyl alcohol, or alcohol.) Alco- 
hol is obtained by fractional distillation from the liquids in which it 
exists, having been formed in 'these by vinous fermentation of grape- 



62 CARDIAC STIMULANTS. 

sugar or starches. These substances are changed under the action of a 
ferment, the former directly into alcohol and carbonic acid ; the latter 
first into glucose, and then undergoing the same change secondarily. 

What important features has alcohol? 

Officinal alcohol, ethyl alcohol (C 2 H 5 OH), is a colorless, inflammable, 
and volatile liquid, having a strong affinity for water, and reacting to 
sulphuric acid, with the production of ether and water. Consisting of so 
large a percentage of unoxidized C and H, alcohol is evidently capable of 
considerable oxidation and consequent energy. The ultimate results of 
oxidation are C0 2 and H 2 0. 

What are its physiological effects? 

The effects of alcohol are (1) primary, which follow when topically 
applied or when circulating as such in the blood ; and (2) secondary, 
which result from long-continued use. 

Locally, alcohol applied to the skin is slightly irritant, especially if 
evaporation be prevented ; abstracts water from the tissues and hardens 
the epidermis ; it evaporates with a cooling and slightly anaesthetic effect. 

Internally, in small doses well diluted, it stimulates glandular secretion 
by (1) causing a superficial congestion of the mucous membrane, and (2) 
by a direct stimulation of the orifices of the glands, causing an outpour- 
ing of their secretion. Hence the appetite and digestive powers are 
promoted. When, however, too concentrated or in too large an amount, 
it precipitates the pepsin secretion, causes nausea, vomiting, and loss of 
appetite, interferes with digestion, and produces certain pathological 
changes to be described later. 

Nervous System. — The cerebral effects vary with the size of the dose. 
They are characterized by mental exhilaration, especially of the emotional 
faculties, often spoken of as stimulation, but it is rather a blunting of the 
higher mental powers of reason and judgment by which the emotional 
are generally controlled : the phases of intoxication are too familiar to 
need enumeration. Somnolence and stupor follow, often very quickly 
when large doses are taken. The other cerebro-spinal effects in their 
order of appearance are — further disorders of intellection, resulting in 
any phase of intoxication or brutality ; disorders of motion and sensa- 
tion : the sensory disturbance may take the form of dysesthesia, pares- 
thesia, or anesthesia, and generally begins in the lower extremities (occa- 
sionally the face) and advances upward : these show an effect on the 
basic ganglia of the brain and the spinal centres ; lack of co-ordinating 
power from (1) disordered cerebellum and (2) impaired muscular sense; 
finally, death from respiratory paralysis, due to involvement of the 
medulla. 

As a general rule, then, the highest centres are first affected, and the 
others in the order of their importance. 

Circulation. — The heart-action is stimulated in force and frequency, or 



ALCOHOL. 63 

in frequency, the individual pulsations being of the same force and the 
diastole shortened : in adynamic states the force of the pulsation is said 
to be increased and the frequency lessened. Thus in medicinal doses 
alcohol is a stimulant to circulation, but toxic doses tend to depress the 
heart's action. Upon the vaso-motor system alcohol acts to dilate the 
cutaneous vessels by vaso-motor paresis ; as results we have flushing of 
the surface, sensations of heat, and sweating. Upon the blood, into 
which the drug is absorbed unchanged, but diluted, it causes (1) diminu- 
tion of oxygenating power by lessening the activity of the red blood- 
corpuscles ; and (2) certain changes in the composition of the blood by 
its effects on the liver and digestion. (See below.) Thus the blood of 
drunkards contains more unoxidized fats and carbon than normal, the 
alcohol combining with much avidity with all the available oxygen. 

The Respiration is at first quickened, but later is depressed, and in 
toxic cases death takes place from paralysis of medulla. 

The Temperature is lowered slightly, for the following reasons: (1) 
The cutaneous circulation is increased and there is a greater loss of heat 
from radiation and diaphoresis ; (2) the oxygenating power of the blood 
is lessened ; (3) there is less muscular activity. This fall of tempera- 
ture is not of importance therapeutically, but it is plain that alcohol is 
not an aid in resisting prolonged exposure to cold, but the opposite. 

Nutrition, — Alcohol is available for immediate oxidation ; hence it is 
an immediate food up to §j to ^ij daily. Other substances ingested at 
the same time may be stored up as body-tissue to be consumed on occa- 
sion. Hence alcohol tends indirectly to produce fat. 

What are the secondary effects of alcohol? 

When habitually used alcohol has certain characteristic effects, mostly 
due to an interstitial hyperplasia. 

Stomach. — The continued irritation of any but very small doses causes 
finally a decrease in its secretory power : there is an increased production 
of connective tissue, the glands are obliterated, and a chronic gastritis 
results. 

Liver, — Alcohol is mostly absorbed in the stomach, and is thus carried 
immediately by the portal circulation to the liver : here, again, constant 
irritation causes growth of connective tissue and consequent gland-oblit- 
eration, and cirrhosis of the liver results. On both stomach and liver 
alcohol acts more harmfully when taken on an empty stomach, because 
of its lesser dilution. Fatty liver may also result from alcoholic habit. 

Vaso-motor Changes. — Alcohol causes a constant paresis of the super- 
ficial vessels, one of the results of which is drunkard's acne. It is also 
a potent factor in the production of atheroma of the vessel- walls. 

Nervous System. — Here too, probably, the effects are due to increased 
connective tissue (neuroglia). Among other conditions thus brought 
about are amaurosis, alcoholic neuritis, epilepsy, general paresis, alcoholic 
tremor, and delirium tremens. 



64 CARDIAC STIMULANTS. 

With what conditions may profound alcoholism be confounded? 

Intercranial hemorrhage, opium narcosis, and cerebral concussion may 
all closely simulate profound alcoholic coma. Diagnosis of these condi- 
tions is by no means easy, and indeed often impossible, in the absence 
of a history of the case. Do not give too much weight to the odor of 
laudanum or alcohol in the breath, nor to the condition of the pupils : 
nothing is positively diagnostic. 

What is the treatment of acute alcoholism ? 

Evacuate the stomach if necessary ; employ warmth to the extremities 
and faradism to the respiratory muscles. 

What are the therapeutic uses'of alcohol ? 

In adynamic conditions, as continued fevers, given in 3ij to §ss doses 
frequently, it really acts as a food rather than a stimulant. 

In acute inflammations with cardiac depression, particularly pneu- 
monia, it is a valuable stimulant. 

In atonic dyspepsia, in small doses with or after meals, it is of benefit 
in some cases, but should not be too long continued, lesc a habit be en- 
gendered ; and the fact that, like all aids to gastric digestion, its contin- 
ued use may lead to ordinary dyspepsia should also be borne in mind. 
The stomach becomes dependent upon them, and wnen they are with- 
drawn dyspepsia ensues. 

In the summer diarrhoea of children, cholera infantum, and diarrhoeal 
disorders generally brandy is particularly serviceable because of its 
astringency. 

Chloroform inhalation should be preceded by §j or ij of whiskey or 
brandy. They are also used with great advantage hypodermically in 
cardiac failure, shock following severe surgical operations, or in any 
sudden depression. 

Alcohol in large doses forms one method of treating diphtheria. 

In pulmonary and other forms of tuberculosis alcohol does good as a 
digestive aid and food. It should be given in small doses with the 
meals ; if digestion is disordered, it is doing harm and should be stopped. 

In delirium tremens it acts as a food and cardiac tonic, and is often 
very valuable, especially in that type of the disease characterized by 
inanition. 

Insomnia may be relieved by some alcoholic beverage just before 
retiring. 

Vomiting is often checked by effervescing wines. 

Locally, alcohol is used as a propr^lactic against bedsores or chapped 
nipples, doing good by hardening the skin, and as an evaporating lotion 
in bruises, sprains, etc. 

How should alcohol be administered? 

In prescribing alcohol remember that patients at the extremes of life, 
childhood and old age, bear the drug poorly. Certain conditions, nota- 



DIGITALIS. 65 

bly shock following injury, venomous bites, and severe hemorrhage, 
call for large doses. Habit causes lessened susceptibility to the drug. 
It should never be prescribed for any great length of time, lest the 
alcoholic habit be formed. 

What preparations contain alcohol? 

The officinal are — 

Alcohol (Rectified Spirit, Spirit of Wine), a liquid containing by weight 
ethyl alcohol 91 and water 9 per cent, (by volume 94 and 6 per cent, 
respectively). 

Alcohol Dilutum, practically equal parts of water and alcohol; used 
only for pharmaceutical purposes; is known as " proof spirit. " 

Spiritus Vini Grallici (Brandy), obtained by the distillation of fermented 
grapes, and at least four years old. _ Contains about 45 to 50 per cent, 
of alcohol by volume. Among the ingredients is tannic acid, to which 
it owes its astringency. 

Spiritus Frumenti, obtained by distillation of fermented grain ; same 
alcoholic strength as brandy, but is not astringent. Should be two years 
old. p 

Vinum Album contains 10 to 12 per cent, absolute alcohol. 

Vinum Album Fortius, 20 to 25 per cent, absolute alcohol. 

Vinum Rubrum, 10 to 12 per cent, absolute alcohol : red wines are 
more astringent than white, as they contain more tannic acid. 

Unofficinal alcoholic liquids in general use are as follows : 

Spiritus Sacchari (or Rum), obtained from the distillation of fermented 
molasses. 

Spiritus Juniper. (Grin) ; this is distilled from rye or barley and fla- 
vored with juniper-berries, to which it owes its diuretic properties, and 
with various other substances as an adulteration. 

Vinum Portense (Port Wine) has 30 to 40 per cent, alcohol ; generally 
formed artificially and heavily fortified. 

Vinum Xericum, also made artificially ; a dry wine. 

The sparkling wines, of which champagne is an example, are sweet, 
contain from 8 to 12 per cent, of alcohol, and are charged with C0 2 . 
They are bottled before fermentation ceases. 

The malt liquors are beer, ale, and porter, in the reverse order of their 
alcoholic strength. They contain from 2 to 6 per cent, of alcohol, be- 
sides extract of malt, C0 2 , etc. 

DIGITALIS. 

What is digitalis ? and what are its active principles ? 

Digitalis is the leaves of Digitalis purpurea, or foxglove, of the second 
year's growth. Its habitat is Europe, but it iscultivated in this country : 
the European leaves are better. The active principles are still in dispute. 
It contains four glucosides : (1) digitalin, which probably most nearly 
represents the drug, and is soluble in alcohol, but not in water ; (2) digi- 

5— M. M. 



66 CARDIAC STIMULANTS. 

talein. soluble in both water and alcohol ; (3) digitonin, which resembles 
saponin in its action, but slightly differs chemically, and is soluble in 
water, but only slightly so in alcohol ; and (4) digitoxin, a very active 
constituent, insoluble in water and only sparingly so in alcohol. Digi- 
tonin probably represents the diuretic action of the drug, and as, being 
insoluble in alcohol, but soluble in water, it is present in the infusion and 
not in the tincture, the former is the better diuretic preparation. 

What are the preparations of digitalis ? 

Pulvis Digitalis, dose gr. j. 

Abstractum Digitalis, dose gr. ss-j. 

Extractum Digitalis, dose gr. J. 

Extractum Digitalis Fluidum, dose ^j-iij. 

Tinctura Digitalis, 15 per cent., dose wiv-3ss. 

Infusum Digitalis, 1.5 per cent. ; gj = about gr. vij of powdered drug : 
is flavored with cinnamon, dose 3j-§ss. 

The unoflicinal digitalin of commerce is of uncertain strength and 
varying composition. Dose about gr. ^. 

What are its physiological effects? 

The most important effects of digitalis are upon the — 

Circulation. — Heart: digitalis strengthens the systole and prolongs the 
diastole of the cardiac cycle. The heart's action thus becomes slower 
and stronger. Lethal doses stop the heart in systole, a tetanic condition. 
The slowness of pulse is due to stimulation of the vagus ; the increased 
strength of the heart-beat, to a stimulation of its muscle and contained 
ganglia. After toxic doses we get a weak and rapid pulse from over- 
stimulation and paralysis of the same points. The vaso-constrictors are 
stimulated, and this, with the increased energy of the heart's action, 
causes greatly increased arterial pressure. Poisonous doses, however, 
paralyze the vaso-constrictors and the arterial pressure is lowered. 

Nervous System. — This is not affected by medicinal doses: after very 
large or toxic doses some cerebral disturbance and lowered reflex excita- 
bility occur. It is also a depressor of motor nerves and muscular tissue. 

Gastro-enteric. — Large doses are irritant, causing nausea, vomiting, at 
times diarrhoea and other symptoms of gastro-enteric irritation. Pro- 
longed use may cause loss of appetite. In acute poisoning empty stom- 
ach if necessary, and give diffusible stimulants, as whiskey or ammonium 
carbonate. 

The Temperature is slightly lowered, but this is not of therapeutic 
importance. 

The urine is increased in amount by digitalis, the urea and uric acid 
being diminished because of lessened tissue-metamorphosis, and the other 
urinary solids increased. Its mode of action as a diuretic is disputed : 
by some it is held to be entirely due to increased blood-pressure in the 



DIGITALIS. 67 

kidneys ; by others that there is a distinct stimulation of the Malpighian 
tufts (Brunton). 
Digitalis stimulates uterine contractions and lessens sexual appetite. 

Is digitalis cumulative? 

By many it is held that after continued administration of the drug 
sudden alarming symptoms may be developed.^ Others deny this, and 
claim that in the strictest sense it is not cumulative, but that these effects 
are due to the slow elimination of the drug, so that the doses overlap 
each other as it were, and that the same would be true of many other 
drugs not considered cumulative. 

What are its therapeutic uses ? When is it indicated ? 

These depend for the most part on its effects on the circulation. Digi- 
talis is indicated — 

In mitral disease, either stenosis or insufficiency; when there is an 
excess of blood on the venous side, the symptoms of which are conges- 
tion of lungs and viscera and rapid, feeble, palpitating, or irregular 
heart, — in these conditions digitalis slows and steadies the pulse and gives 
the auricle a chance to empty itself. 

In aortic disease its sphere is more limited. In stenosis ivith compen- 
satory hypertrophy it is not indicated, and may prove dangerous in large 
doses, but when this stenosis has secondarily affected the mitral valve, 
digitalis is useful, " In general terms, it is indicated when the action of 
the heart is rapid and weak and the arterial tension low " (Bartholow). 

When is it contraindicated ? 

Digitalis should be used with care in the following conditions : fatty 
heart; aneurism and cerebral endarteritis, in which conditions the in- 
creased blood-pressure might rupture the already weakened wall and 
cause fatal hemorrhage ; in an}^ valvular lesion with compensatory hyper- 
trophy, or when such hypertrophy is evidently taking place. 

What should be our guides in administration? 

Bartholow advises us to be guided in its use rather by rational symp- 
toms than by physical signs ; the symptoms calling for its use being a 
rapid and feeble heart, low arterial tension, signs of pidmonary conges- 
tion (as cough, dyspnoea, cyanosis, and possibly hgemoptysis), and signs 
of general congestion (as pulsating jugulars and general oedema). Again, 
we are warned by another therapeutist against being guided in its use by 
mere signs of dilatation or hypertrophy, but rather by the way the heart 
is acting in relation to the increased duties it is called upon to perform. 

Digitalis is also of value in irritable heart from excessive exertion, as 
seen in oarsmen, soldiers, etc. — a condition of muscular hypertrophy: 
from its double diuretic action it is valuable in renal dropsies, especially 
that of acute exudative nephritis, but still it does good in the chronic 
varieties : for this purpose the infusion should be given. In cardiac 
dropsies it is particularly valuable, In exophthalmic goitre digitalis 



68 CARDIAC STIMULANTS. 

relieves the tachycardia and palpitation. In adynamic conditions, as 
typhoid, it is often very useful In poisoning by certain drugs which 
arrest the heart in diastole and greatly diminish the blood-pressure, as 
aconite or muscarine, it is used with advantage. In pneumonia and 
other acute inflammations it has been used in the early stages with the 
view of lessening exudation, but is of doubtful efficacy ; later it is often 
indispensable as a stimulant, especially in alcoholic cases. In passive hem- 
orrhages, the hemorrhagic diathesis, and purpura it may be beneficial. 
In menorrhagia and metrorrhagia it will only prove serviceable when 
the condition is due to cardiac disease. In spermatorrhoea it is supposed 
to act as an anaphrodisiac. Hypodermic injections of its tincture, w\,xv 
to xxx, are valuable in sudden cardiac depression from any cause, as dur- 
ing operation or acute hemorrhage ; but it is more irritating and slower 
of action than the tincture of strophanthus, which is therefore preferred. 
Digitalis poultices over the lumbar region in the uraemic state, the patient 
not being able to swallow or vomiting repeatedly, seem to do good, prob- 
ably more from their heat than from the drug, very little of which can 
be absorbed. 

What are the symptoms of digitalis-poisoning? When are they 
apt to develop ? 

The characteristic symptoms of poisoning by digitalis are g astro-intes- 
tinal and ciradatory nausea, vomiting, diarrhoea, profound depression, 
marked pallor of face, with a pulse which, while it may be full, strong, 
and slow in the recumbent position, becomes rapid, weak, and irregular 
when the patient assumes a sitting posture. These symptoms may fol- 
low continued use of the drug, and are said to be more apt to develop 
(1) after tapping in ascites or hydrothorax, which relieves lymphatic 
pressure and facilitates absorption ; (2) after quick defervescence from 
some acute disease ; or (3) when its diuretic action is not marked. 

How should these symptoms be treated? 

The treatment consists in the immediate withdrawal of the drug, keep- 
ing the patient in the recumbent position, and the administration of dif- 
fusible stimulants, as alcohol and ammonia. The minimum fatal dose 
of digitalis is not known. 

STROPHANTHUS. 

What are its important botanical and chemical properties ? 

Strophanthus is the pods of Strophanthus hispidus and other varieties 
of Strophanthus, a tropical climbing shrub. The seeds yield an intensely 
bitter glucoside, strophanthin, which is converted by sulphuric acid into 
glucose and strophanthidin. 

What are its physiological effects ? 

Its most obvious effects, and the most interesting from a therapeutic 
standpoint, are circulatory. In medicinal doses (r^v to x of the 5 per 



COKVA LLAMA MAJALIS. 69 

cent, tincture) it slows the action of the heart, increases its capability for 
work, and raises the blood-pressure. Its cardiac effects are probably due 
to a direct stimulation of the heart itself, while the increased arterial 
tension is secondary to this stimulation, together with some local stimula- 
tion of the arterial constrictors. Poisonous doses paralyze the heart and 
greatly reduce the blood-pressure. 

Upon the nervous system the drug acts very slightly, but it is a mus- 
cular paralyzer, first increasing the tonicity of the muscular fibre, and 
then destroying it, the dead muscle passing directly into a state of post- 
mortem rigidity. Death generally results from cardiac depression, but 
possibly at times from paralysis of respiration. Its diuretic effects are 
disputed, but the weight of opinion seems to be that it acts as such in 
both health and disease, and especially in cardiac disorders. Large doses 
cause some irritation of the mucous membrane of the alimentary tract, 
but less than digitalis. Strophanthus is eliminated in the urine. 

What are its uses and administration? 

Strophanthus may be used to fulfil the same indications as Digitalis 
(q. v.). differing, however, from that drug in being much quicker of 
action and less protracted, and perhaps less certain. Thus it may be 
substituted for digitalis when a quick effect or a change of medication is 
desired. 

Strophanthus was not officinal in the U. S. P. of 1880. Two tinctures 
are in use : one is 1 : 20, the other 1 : 8. The former is most used, dose 
tt^v-x or nUj-iij, frequently repeated. Strophanthin is a powerful drug, 
and has been used hypodermically in gr. x£o ~ wo doses. 

CONVALLAMA MAJALIS. 

What are its origin and active principles? 

Convallaria majalis, the "lily of the valley," is an indigenous plant 
of the Nat. Ord. Labiate. It contains two glucosides — convallarin, 
which is a purgative principle ;and convallamarm, which represents the 
drug in its effects upon the circulation. 

What are its effects physiologically? 

The rationale of its action is still obscured by a multiplicity of experi- 
ments with diverse results. It acts, however, at first to slow the pulse- 
rate, to raise the arterial pressure, and probably to stimulate the respira- 
tory function. Later, after large doses, it depresses all these functions, 
thus resembling digitalis to a degree, but being less energetic and pass- 
ing less readily into the toxic stages. It acts as a diuretic, probably 
indirectly, by increasing the blood-pressure. 

What are its uses? 

It is recommended in dropsies of all kinds and in valvular lesions of 
the heart, probably fulfilling the indications for digitalis. 



70 CARDIAC STIMULANTS. 

SPARTEINE. 
What is sparteine? 

Sparteine is a volatile liquid alkaloid from Sarothamnus scoparius, or 
broom-plant. It is colorless, extremely bitter, insoluble in water, but 
soluble in alcohol, ether, and chloroform. Its sulphate, the form in 
which it is used, is freely soluble in water. 

What are its effects? 

These are little understood at present. It seems to increase the con- 
tractile energy of the heart and to exercise a peculiar steadying influence 
upon its action when irregular, with very little or no effect on the vascu- 
lar tension. It increases the amount of urine, but whether it represents 
the entire diuretic power of its parent drug, or whether it has any 
direct kidney effects, is not clear, ft depresses the central nervous 
system and kills by respiratory paralysis. 

What are its uses ? 

It has been employed in valvular disease, asthma, and conditions 
characterized by cardiac depression, with dropsy, but seems particularly 
adapted to the functional or nervous disorders of the heart. Like other 
members of this group, it is recommended in Graves' disease, and may 
do good. 

ADONIDIN. 

What is its source ? and what are its effects ? 

Adonidin is a glucoside derived from Adonis vernalis, a European 
plant (Nat. Ord. Ranunculaceae). Its effects resemble digitalis. Small 
doses slow the heart's action and increase the blood-pressure, while large 
doses depress both. It is irritant to the digestive tract, but only in 
very large doses. 

What indications does it meet ? 

The indications for this drug, resembling digitalis as it does very 
closely in its effects, may be considered the same as for that drug. It 
may be substituted, and is generally administered in the form of a 2 to 4 
per cent, infusion of the whole herb, the dose of which is ^ss every two 
or three hours. 

CAFFEINA (CAFFEINE). 

What are its source, nature, and physical properties ? 

Caffeina is a proximate principle of feebly alkaloidal powers prepared 
from the leaves of Camellia Thea (tea) or the seeds of Caffea Arabica 
(coffee), and occurring also in guarana and other plants. It occurs in 
white, silky, odorless crystals, soluble in 100 parts of water, the solution 
being neutral in reaction, but forming salts with acids. 



CAFFEINA. 71 

What are its officinal and non-officinal preparations ? 

Caffeina, the alkaloid itself, dose gr. j-v. 
Caffeinae Citras, non-officinal, dose the same. 

What effects does it produce ? 

In small doses caffeine is a stomachic tonic, promoting the appetite 
and increasing the digestive power. In larger amounts it causes cerebral 
excitement, with stimulation of the higher mental powers (whereas 
opium stimulates the imaginative). Still larger doses cause mental con- 
fusion, hallucinations, muscular trembling, and even delirium. It is, 
then, a true stimulant to the ceixbral cortex. In animals convulsions, and 
in man muscular tremulousness, are produced, the exact origin of which 
is not known. Probably they are due to stimulation of spinal centres 
and to muscular depression. 

Circulation. — This function, upon which the physiological effects are 
especially interesting in view of the therapeutic uses of the drug, is at 
first stimulated and later depressed. The heart's action is at first ren- 
dered more rapid and the arterial pressure is raised, but later the pulse 
becomes slower and irregular and the blood-pressure falls. No exact 
explanation of these effects can at present be vouchsafed, but probably 
it is due in large part to a direct stimulation of the cardiac nervo-mus- 
cular apparatus. Toxic doses depress both circulation and respiration 
and lower the temperature. It acts as a powerful diuretic, the amount 
of urine being decidedly increased. The effect upon the solids eliminated 
is still under discussion. 

Elimination. — Small does are entirely destroyed in the system ; large 
amounts are partially eliminated in the urine. 

What is the therapy of caffeine ? 

In migraine and other nervous headaches with or without gastric de- 
rangement it is an uncertain remedy, in many cases, however, acting well. 

In opium narcosis it is a standard remedy, either in the alkaloid al form 
or as black coffee. 

In adynamic conditions generally it may be used in either of these two 
forms as a cardiac stimulant. 

In all forms of cardiac inefficiency the indications for its use are the 
same as for digitalis. 

In renal and cardiac dropsies it is valuable, and in ascites of hepatic 
origin it succeeds when any diuretic is of avail. It differs from digitalis 
in the promptness and comparatively brief duration of its effects, and is 
less apt to cause gastro-intestinal disturbance. 

Its complete destruction in the S3 7 stem would seem to indicate that it 
is in some degree a supporting element or food. 

What is its toxicology and how is its poisoning treated ? 

Poisoning by caffeine is rare. Its antagonists are tannic acid and 
potassium iodide, chemically, and opium, physiologically. 



72 CARDIAC DEPRESSANTS. 

OARDIAO DEPRESSANTS. 

ANTIMONIUM (ANTIMONY). 

Antimony and its salts now enjoy much less reputation than formerly. 
What are the principal preparations of antimony ? 

The* preparations of antimony most in use are — 

Antimonii et Potassii Tartras (tartar emetic or tartarized antimony), 
dose gr. ^-j. 

Vinum Antimonii (tartar emetic gr. 1.8 to §j), dose tr\,x-3j. 

Syrupus Scillae Compositus (tartar emetic gr. j to §j). 

Antimonii Oxidum and Antimonii Sulphidum are officinal "for 
pharmacopoeial use." Antimonii Sulphuratum, Pilulse Antimonii 
Comp., and Pulvis Antimonialis are officinal, but no longer used. 

What are the effects of antimony ? 

Tartar emetic may be taken as a type of the antimonial preparations. 
Locally, it is an irritant, and if continued may produce an eruption of 
papules, vesicles, and pustules resembling small-pox. Taken internally 
in sufficient doses, it acts as a gastro-intestinal irritant, producing violent 
and protracted vomiting (which in rare cases may be absent even in poi- 
soning), abdominal pain, choleraic diarrhoea with perhaps bloody stools, 
profound depression, collapse, and death. Two grains have caused death 
in an adult, gr. f in a child. If given in gradually increasing doses 
marked tolerance may be established. For emetic action see Emetics. 

Circulation. — Tartar emetic is a direct depressant of the heart-muscle, 
which does not respond to stimulation after death, and this, together 
with a direct paretic effect on the vaso -constrictors, causes extreme 
diminution of the vascular tension. 

The spinal cord is depressed especially, it is claimed ; the sensory por- 
tion and the reflexes are "consequently diminished. 

Respiration also is depressed by a direct action on its centre, and indi- 
rectly by the venous congestion and blood-changes. 

Secretions. — Antimonial preparations increase them generally, and 
especially those of the skin, bronchi, and intestinal tract, and, like other 
metallic salts, are probably eliminated by the intestine. 

What therapeutic uses has tartar emetic, if any? 

Tartar emetic is employed as a nauseant, emetic, sudorific, and expec- 
torant, and locally as a counter-irritant. Practically, its use is now lim- 
ited to the dry stages of laryngitis, bronchitis, and asthma, in the first 
two of which it produces secretion, and in the last relaxes spasm as well. 

What are its toxicology and treatment? 

Enough has been said of the symptoms, which are those of gastro- 
intestinal irritation, cardiac depression, and collapse. Poisoning by anti- 
mony may closely simulate cholera. The treatment consists of tannic 



TEHATRtTM VIEIDE. 73 

acid, which forms an insoluble tannate, the hypodermic exhibition of 
morphine, and free stimulation. 

VERATRUM VIRIDE. 

What are its source and active principles? 

This drug consists of the rhizome and rootlets of Veratrum viride, an 
indigenous plant known as American or swamp hellebore, Indian poke, 
poke-root, etc. It contains two alkaloids, jervine and veratroidine, which 
differ physiologically in some respects. 

What are its officinal preparations? 

Extractum Veratri Viridis Fluidum, dose w\j to iv. 

Tinctura Veratri Viridis (1 : 2), dose ttliij to x. 

Norwood's tincture is one-tenth stronger, and is not much used. 

What are the physiological effects of jervine? 

Jervine is a white powder, insoluble in water, ether, and alcohol, solu- 
ble in chloroform. It acts directly to depress the cardiac muscle, does 
not affect the vagus, and lowers arterial pressure both by cardiac depres- 
sion and by vaso-motor paralysis : the pulse-rate is diminished. Reflex 
excitability is also diminished by a direct depression of the spinal reflex 
centres. Respiration is affected, and death occurs after large doses from 
paralysis of this function. 

What effects has veratroidine ? 

Veratroidine, which may yet be found to be a compound substance, 
and closely resembles veratrine, causes emesis, and at times catharsis, by 
by its local irritation. Like its companion alkaloid, it lessens the reflexes 
and paralyzes respiration. It acts as a direct paralyzant to the heart- 
muscle, and indirectly through the vagus, and does not affect the arterial 
tension except by depressing the heart, having no*effect on the vaso-motor 
system : before death the tension rises greatly from respiratory embar- 
rassment. 

How does veratrum viride itself act? 

The parent drug itself in moderate doses causes languor, muscular 
weakness, and inco-ordination, and quiets the circulation, lessening the 
pulse-rate and lowering the arterial tension. Cases of poisoning are 
rare, as the emetic action of the veratroidine protects to a great degree 
against this, and the patient responds easily to stimulation. This ren- 
ders it the safest and most manageable of all the cardiac depressants. 

What are the therapeutic uses of veratrum viride ? 

Veratrum viride maybe used to depress the circulation and lessen in- 
flammatory exudation in acute inflammations, as the early stages of 
pneumonia, pleurisy, etc., but it is contraindicated in abdominal inflam- 
mations, because of its tendency to produce vomiting, and in asthenic 



74 CARDIAC DEPRESSANTS. 

conditions generally because of the depression produced. It should be 
given guarded by small amounts of opium to prevent vomiting. 

How is poisoning by this drug treated? 

In toxic cases the recumbent position must be strictly enforced, with 
elevation of the foot of the bed, and large draughts of warm water given 
to wash out the stomach. Opium and free stimulation with alcohol or am- 
monia by the rectum or hypodermically, and general warmth to the body, 
complete the treatment, which is generally successful. Large amounts 
have been recovered from, and the minimum fatal dose is not known. 

How should it be administered? 

Veratrum viride should be given preferably as the fluid extract, com- 
bined with tincture of opium, and in gradually increasing and frequent 
doses until its physiological effects upon the circulation are manifested. 

What is veratrina ? 

Veratrina is a powder, presumably a mixture of alkaloids, derived 
from Asagrcea officinalis. When pure it is cr} 7 stalline. It is extremely 
irritant when applied to any surface. It acts upon the circulation simi- 
larly to veratrum viride, but is also a motor paralyzer, and at times 
causes convulsions before the paralysis. Its therapeutic uses are very 
limited. 

ACONITUM (ACONITE). 

What is aconite ? what does it resemble ? and to what does it 
owe its efficiency? 

Aconite is the tuberous root of Aconitum Napellus (wolfs bane or 
monk's hood), a plant of Europe and Asia. It resembles horseradish, 
and when mistaken for this has caused fatal poisoning. It is differ- 
entiated from horseradish by its lack of odor when scraped and the 
brown color of its cortex. It has a bitter, acrid taste, with a benumb- 
ing after-effect on the mouth and tongue. It contains as its active prin- 
ciple an alkaloid, aconitine, with a peculiar acid called aconitic acid. 
Other alkaloids are described, but the information is so much at variance 
that they are better omitted. The preparations called aconitia vary 
greatly in potency, Aconitine is a bitter, acrid, odorless, whitish-yellow 
powder, producing numbness of the mucous membranes, partially soluble 
in water, while its salts are wholly so, and readily dissolved by aicohol or 
chloroform. 

What are its preparations? 

Abstractum Aconiti, dose gr. ss-j. 

Extractum Aconiti, dose gr. J-}. 

Extractum Aconiti Fluidum, dose ™lj-nj. 

Tinctura Aconiti (40 per cent.), the best preparation, ^Iss-v. 

Fleming's tincture is twice as strong as the officinal, and is chiefly 



ACONITUM. 75 

I externally. huqiiesnel's aconitia is crystalline and reliable : its com- 
mencing dose ig _T. .,',,,. 

What are the effects of its administration ? 

Topically, aconite produces numbness and tingling by its effect on the 

sensory nerve- end n. 

Nervous System. — The r-erebrum is unaffected by ordinary doses; the 
reflexes are diminished largely from paralysis of the peripheral sensory 
nerves, but partly perhaps by paralysis of the motor nerves as well. 

Circulation. — This is depressed, the pulse-rate becoming at first slow. 
then weak and rapid, and finally irregular from direct action upon the 
contained motor apparatus of the heart. The primary slowing is attribu- 
table to stimulation of the inhibitory apparatus (?). The arterial pres- 
sure is greatly lessened — whether from any specific action is not clear. 

The Respiration is depressed and temperature lowered, the former 
from a centric action, the latter from lessened oxidation and increased 
sweating. The secretion of urine is increased, and the drug is pre- 
sumably eliminated therein. 

Large doses produce local numbness and tingling (later becoming 
general), motor weakness, a sense of constriction of the throat, occasion- 
ally nausea and vomiting, and always salivation, diaphoresis, and diure- 
sis, with circulatory and respiratory paralysis and lowered temperature. 
After toxic doses the effects are augmented, and there are added collapse 
with cold, clammy perspiration, stiffness and pallor of the face, dilated 
(or contracted) pupils, and finally CO., narcosis, with death from res- 
piratory or cardiac paralysis, preceded it may be by convulsions. 

What are the diagnosis and treatment of poisoning ? 

Tingling of the entire body-surface, and especially of the mouth, face, 
and extremities, is the diagnostic symptom. The indications are imme- 
diate evacuation of the stomach, recumbent posture, heat locally, free 
stimulation, and artificial respiration if the respiratory function fails. 

Of what therapeutic use is aconite ? 

From its benumbing effects on the sensory nerves it is a valuable ap- 
plication in all painful affections of nerves, and internally is especially 
efficacious in the trifacial variety. It is of use in chronic rheumatism, 
gout, and other painful diseases. By reducing the activity it is of 
value in — 

Acute tonsillitis and pharyngitis, in which conditions it is almost 
specific, acting as an analgesic to the painful parts, as well as antiphlo- 
gistic. 

In acute pulmonary inflammations, as bronchitis, pneumonia, etc.. its 
effects are good during the early stages. 

In acute pleurisy and peritonitis, before the effusion takes place, it is 
doubly serviceable from the analgia produced. 

In febricula and exanthemata it reduces temperature, and may palli- 



76 CARDIAC DEPRESSANTS. 

ate or exert a prophylactic influence against the complications of the 
latter. 

Urethral chill after catheterization may be prevented, but with careful 
attention to asepsis this will seldom occur. It is also recommended in 
septic conditions (as puerperal fever), facial erysipelas, over-acting heart, 
and intestinal fluxes, but is not so much used for these purposes as 
formerly. 

PULSATILLA. 

What is the source of Pulsatilla ? 

It is the herb of Anemone Pulsatilla, A. pratensis, and A. patens, 
found in both hemispheres, and containing an acrid oily principle which 
is easily converted into anemonin, a volatile, camphoraceous product, and 
anemonic acid, which is physiologically inert. The dose of the powder 
is gr. ij to iij. No other preparations are officinal, but of a non-officinal 
tincture the dose is oss. 

What are its effects and uses ? 

Pulsatilla is an irritant to the skin and mucous membranes, and a 
depressant to the circulation, respiration, spinal centres, and peripheral 
nerves. It dilates the pupils and causes diuresis and diaphoresis, and is 
eliminated by the urine. It thus closely resembles aconite. It has 
proved useful in acute catarrhs of the nasal, faucial, laryngeal, and 
bronchial mucous membranes, but probably only in the early stages, like 
other depressants, and is contraindicated in inflammations of the gastro- 
intestinal tract, because of its irritant tendencies. It has a good repu- 
tation in epididjmiitis and functional amenorrhoea and dysmenorrhoea. 



ARNICA. 
What is its source ? 

Two parts of this herb, Arnica montana, or leopard's bane, are offici- 
nal — arnicae flores (flowers) and arnicae radix (rhizome and rootlets). 

What are the preparations of arnica ? 

The number of officinal preparations is in inverse ratio to the thera- 
peutic importance of the drug. They are — 
Tinctura Arnicae Florum (20 per cent.), dose tt^x-^ss. 
Tinctura Arnicae Radicis (10 per cent.), dose wixx-3ss. 
Extractum Arnicae Radicis, dose gr. iij-v. 
Extractum Arnicae Radicis Fluidum, dose ^iv-x. 
Emplastrum Arnicae {i extract). 

What are its effects and uses ? 

Locally, arnica and its preparations are irritant, producing a decided 
eczema on delicate skins, and decided symptoms of gastric irritation 
when taken internally. Of its systemic effects very little is known. It 



STAPHISAGRIA. ACIDUM HYDROCYANICUM. 77 

appears to be a decided cardiac depressant, having, however, less effect 
on the vaso-motor system than most drugs of this class. It is not used 
to any extent internally. The tincture of the root is used locally. 

STAPHISAGRIA. 

What is staphisagria ? and what are its principal effects and 
uses? 

This drug is the seeds of Delphinium staphisagria, stavesacre or lice- 
bane, a flowering plant of Southern Europe. _ These contain an alkaloid, 
delphinine, which acts locally as a rubefacient and even irritant, and 
internally as a cardiac and respiratory depressant and paralyzer of vol- 
untary muscles. _ The principal symptoms produced are dyspnoea, sali- 
vation, and vomiting. The seeds contain other alkaloids of unknown 
activity. It has been recommended in rheumatism, dropsy, vomiting of 
pregnancy, etc., but its chief use is as a parasiticide ointment (3j-ij of 
seeds to %]) in phtheiriasis and scabies. 

ACIDUM HYDROCYANICUM (HYDROCYANIC ACID). 

What are the properties of hydrocyanic acid ? 

Pure hydrocyanic acid is a colorless, transparent, inflammable liquid, 
extremely deadly even when inhaled, which accident, owing to its ex- 
treme volatility, may occur when carelessly handled. It occurs in small 
amounts in a number of vegetable substances, especially in the bitter 
almond, peach-kernel, wild cherry, and cherry- laurel. It is not used in 
medicine. 

What preparations used medicinally contain hydrocyanic acid ? 

Acidum Hydrocyanicum Dilutum, a# per cent, watery solution, formed 
by the reaction of potassium ferrocyanide and sulphuric acid, or by pre- 
cipitating cyanide of silver from its solutions by means of hydrochloric 
acid. Under the influence of light it decomposes and deteriorates ; dose 
wij-iv. 

Potassii Cyanidum, dose gr. -^ to J. 

Potassii Ferrocyanidum, used only as above indicated. 

Oleum Amygdalae Amarae contains hydrocyanic acid, varying in 
amount, and developed from a principle called amygdalin, under the 
influence of emidsin, a ferment. It is about four times as strong as the 
officinal dilute acid, and the dose is accordingly gr. I to J. 

What are the effects of hydrocyanic acid ? 

Locally applied, the drug causes numbness, and may be absorbed by 
the mucous membranes. 

Nervous System. — Small doses produce simply a calming effect upon 
the cerebrum, while larger ones cause giddiness, confusion, and convul- 
sions which have been shown to be of cerebral origin, not occurring in 



78 CARDIAC DEPRESSANTS. 

parts below a section of the spinal cord. The motor and sensory nerves 
and the spinal centres are depressed. 

Circulation. — Small doses simply quiet the heart, while toxic doses 
stop it in diastole, apparently from a direct effect on its muscle and con- 
tained ganglia. The vaso-motor system is paralyzed after a brief 
period of stimulation. Blood-changes occur, the exact nature of which 
is not clear. There is at first excessive oxidation of the blood, the venous 
becoming of arterial hue, and later excessive carbonization. Outside the 
body a mixture of this drug with the blood produces cyano -haemoglobin, 
which has little or no ozonizing power. This may take place in the 
body, and be one of the causes of death. 

Respiration. — Ten to fifteen minims produce disturbance of this func- 
tion, rendering it labored and irregular. Toxic doses cause death by 
paralysis of the respiratory centre. The muscles, both voluntary and 
involuntary, are affected by the drug, and lose partially or in toto their 
power of electric excitability after death. Elimination is rapid by the 
saliva, kidneys, and lungs, so that those who barely escape toxic effects 
rally very quickly. 

What are its toxicology and treatment? 

After overwhelming doses death may take place almost immediately, 
with hardly any prior symptoms. In the slower forms three stages are 
recognized (Wood) : (1) a very brief period characterized by depression 
of all the organic functions, especially respiration and circulation; (2) a 
convulsive stage, in which the pupils are dilated, convulsions with spas- 
modic evacuations occur, and unconsciousness supervenes; (3) a stage 
of asphyxia, paralysis, and collapse. The most diagnostic points are the 
suddenness of the development of the unconsciousness and other symp- 
toms, and possibly the recognition of the odor of prussic acid in the 
breath. The treatment is generally of no avail. Evacuation of the 
stomach, ammonia by inhalation and hypodermically, and artificial 
respiration are indicated, remembering that either a fatal termination 
or recovery may be expected quickly. 

What are the uses of hydrocyanic acid ? 

Hydrocyanic acid is used as an antispasmodic and analgesic in a variety 
of conditions, as in gastrodynia and neuralgic abdominal conditions, and 
in checking persistent vomiting ; in the coughing of bronchitis, pulmonary 
tuberculosis, and the spasmodic cough of pertussis and asthma ; it is a 
favorite ingredient of cough mixtures, generally in some combination with 
opium ; to allay irritability of the cutaneous nerves in neuralgia, urti- 
caria, and prurigo ; locally, 3j-ij to water Oj. 

What is its administration? 

The dose of the officinal preparation is one to three drops, gradually 
increased, remembering that it is unstable and apt to vary in strength. 



POTASSIUM CYANIDE.— ACETIC ACID. 79 

POTASSIUM CYANIDE. 
What are its production, effects, and uses ? 

Cyanide of potash is formed by heating potassium ferrocyanide with 
potassium carbonate (U. S. P.). It is non-crystalline, of characteristic 
odor and taste, deliquescent, and readily soluble in water. Being con- 
verted by the stomach acids into prussic acid, its physiological and toxic 
effects are the same, and it may be substituted therapeutically. Five 
grains have proved fatal ; dose should not exceed gr. i. 

Oleum amygdalae amarse is to be carefully discriminated from 
the expressed oil of almonds, the dose of which is ad libitum. Of the 
aqua amygdalae amarae (1 : 1000) the dose is Sij-^ss. 

VEGETABLE ACIDS. 

What are the officinal members of this group ? 

The officinal vegetable acids are tartaric, citric, and acetic, the last only 
being liquid, the others solid. They are all slightly cardiac depressants, 
and from their u refrigerant " effects — which, by the way, are by no 
means marked — may be considered here. They affect secretion, as do 
the mineral acids, increasing the alkaline and decreasing the acid secre- 
tions of glands with which they come in contact. Thus the salivary and 
intestinal secretions are increased. They all increase and slightly acidify 
the urine, and after continued use are apt to derange the digestion. 

CITRIC ACID. 

What are its occurrence, effects, and uses? 

Acidum Citricum, citric acid, is the familiar acid of lemon- or lime- 
juice. It is generally used in the former (succus limonis, the juice of 
Citrus limonum). It is the mildest of the acids, non-toxic in man, and 
a certain prophylactic against and specific for scurvy. It has been used 
with good effect in acute rheumatism, but is inferior to the alkalies and 
salicylates. 

TARTARIC ACID. 

What are its preparation, effects, and uses? 

Acidum Tartaricum, tartaric acid, is the acid of grape-juice, and is 
prepared from argol, or crude cream of tartar. It is the only one of 
the vegetable acids which yields a precipitate (cream of tartar or potas- 
sium bitartrate) with solutions of neutral potassium salts. It is cheaper 
than citric acid, and may be substituted for it. Its chief use is in the 
Seidlitz Powder (q. v.) and other effervescing draughts. 

ACETIC ACID. 
What are its preparations and their uses? 
Acidum Aceticum, the officinal acid, is a liquid containing 36 per cent. 



80 ASTRINGENTS. 

of monohydrated acetic acid, and is used as a mild caustic to warts and 
exuberant granulations. Acidum Aceticum Dilutum contains 6 per cent, 
of the same, and is the only preparation employed internally. Acidum 
Aceticum Glaciale is nearly absolute, is a crystalline solid at or below 59° 
P.', and is emplo};ed as a caustic only. Acetum (vinegar) is itself officinal. 
The dilute acid is somewhat used as a refrigerant. Locally, it is a cool- 
ing and pleasant application in febrile conditions and in superficial cuta- 
neous inflammations, as sunburn, while injections of vinegar and water 
are said to be useful in vaginal gonorrhoea. 

OXALIC ACID. 

Of what interest is oxalic acid ? 

This vegetable acid is not used in medicine, and is interesting only 
from its toxic effects. 

What are the symptoms of oxalic-acid poisoning? What is the 
treatment ? 

The poison is taken either as the acid itself or as the acid oxalate of 
potassium (or "essential salt of lemons"). The S3 T mptoms produced 
are intense burning in the region of the oesophagus and stomach, ab- 
dominal pain, vomiting of an acid, generally bloody mucus, collapse, 
and in some cases paralysis. The autopsy shows erosions and perhaps 
perforation of the stomach, and an excess of oxalate crystals in the 
kidneys. The antidote is lime or chalk in the most quickly available 
form, as whitewash, or the precipitated calcium carbonate or syrup of 
lime may be administered. 

ASTRINGENTS. 
What are astringents? 

Astringents are medicines which produce corrugation and contraction 
of the tissues by their local action. They are employed as tonics, as 
correctives to relaxation of tissues, and to prevent excessive secretory or 
hemorrhagic discharges. They are divided into vegetable and mineral 
astringents. 

What are vegetable astringents? 

This class includes a large number of drugs acting as above indicated, 
and possessing this power by virtue of tannic acid or its derivative, gal- 
lic acid. 

ACIDUM TANNICUM (TANNIC ACID). 
What are its chemical and physical properties ? 

Tannic acid is derived from nut gall by the action of washed ether, the 
water being the solvent agent. It is a yellowish-white, non-crystalline 
powder of astringent taste, and easily soluble in water. It precipitates 



ACIDUM GALLICUM. 



81 



albumin, gelatin, and the alkaloids, and with iron salts forms ink. It is 
a glucoside, being changed by dilute mineral acids into glucose and gallic 
acid, and is gallic anhydride, or gallic acid minus 1 molecule of water. 

What are its preparations? 

Acidum Tannicum, dose gr. j to xv. 
Trochisci Acidi Tannici ; each contains gr. j. 
Unguentum Acidi Tannici, 20 per cent. , in cacao butter. 

In what way are its effects produced? 

Its effects throughout are due to a local action. It coagulates the 
tissue- albumin, lessens the calibre of superficial vessels, and causes 
diminished secretions wherever applied. It checks peristalsis. It is 
absorbed after conversion into gallic acid, is reconverted into tannic acid 
in the blood (?), where it exists as an albuminate, and is eliminated by 
the kidneys and intestinal canal as gallic, tannic, and pyrogallic acids. 
Injected into the blood, it causes multiple thrombosis. 



ACIDUM GALLICTJM (GALLIC ACID). 

What are its source and properties ? 

Gallic acid is obtained by oxidation or hydration of tannic acid, either 
slowly by exposure to the atmosphere or quickly by means of dilute sul- 
phuric acid. It is crystalline^ slightly soluble in cold water, but readily 
so in alcohol, and should be given in alcoholic solution, from which it is 
not precipitated by water. 

What are its preparations ? 

Acidum Gallicum, dose gr. v-xv. 
Unguentum Acidi Gallici (10 per cent.). 

How do its eifects differ from those of tannic acid ? 

It is less irritant, and therefore preferable for internal administration 
with a view to remote astringency, although some writers deny to it any- 
thing but a local astringency. Its local effects are similar to, but less in 
degree than, those of tannic acid. The following table expresses these 
differences and others : 



Tannic Acid. 
Non-crystalline. 
Soluble in water. 
Not readily absorbed as such. 
Precipitates albumin and gelatin. 
Locally astringent only. 

What are the therapeutic differences of tannic and gallic acids ? 
From their different physiological action various differences result 
in their use. Thus, tannic acid is valuable in hemorrhages and increased 
6— M. M. 



Gallic Acid. 

Crystalline. 

Slightly soluble only. 

Readily absorbed. 

Does not. 

Remotely (?) astringent. 



82 ASTRINGENTS. 

secretions where local application is possible, as in hcematemesis and intes- 
tinal hemorrhages, either from simple or typhoid ulcers or from portal 
congestion, but not in those resulting from acute inflammation ; in epis- 
taxis and oozing from large surfaces, as a styptic ; in gastric catarrh 
from relaxed conditions of the mucous membrane ; in diarrhoeas when 
acute stages have subsided, and especially in chronic diarrhoea, chronic 
dysentery, and the colliquative diarrhoea of phthisis, generally with 
opium ; in mercurial stomatitis, elongated uvula, and relaxation of the 
palate, as a mouth- wash or gargle ; in the various forms of con- 
junctivitis and keratitis ; in chapped nipples and soreness of the feet, 
to harden the skin : for the former glycerite of tannin is especially good ; 
as an antidote to all the alkaloids and to tartar emetic : with the former 
it forms an insoluble tannate ; in hemorrhoids it is a good ingredient in 
ointments ; in catarrh of the cervix and body of the uterus tampons of 
glycerite of tannin, or iodoform and tannin in powder form, are particu- 
larly valuable ; in the chronic vulvitis or chronic otorrhoea of children 
glycerite of tannin is of service. 

Gallic acid is used as follows by those who consider it to have a 
remote action : 

In pulmonai~y and renal hemorrhage ; in the hemorrhagic diathesis, 
as evidenced by menorrhagia, haematuria (when not malarial), epistaxis, 
or purpura, it should be given, alternating but not combined with iron 
compounds, or combined with ergot and digitalis ; in chronic bronchitis 
with profuse expectoration ; in the colliquative sweating of pulmonary 
tuberculosis it is often used, combined with belladonna or hyoscyamus or 
alternating with zinc oxide. 

The following vegetable astringents owe their activity principally to 
the tannic acid they contain : 



G-ALLA. 

What are its source, preparations, and uses ? 

Galla, or nutgall, is the excrescences on Quercus lusitanica (variety 
Infectoria), or dyer's oak, caused by the puncture of an insect {Gynips 
quercusfolii) for the purpose of depositing its ova. It yields its proper- 
ties to water and alcohol, more readily to the former. Two varieties are 
recognized, black and white galls, the latter being inferior in strength. 
Tannic acid is present in about 60 per cent., gallic acid 3 per cent. 
The preparations are — 

Tinctura Uallae (20 per cent.), dose 3j-iij. 

Unguentum Gallse (10 per cent.). 

Nutgall is not much used internally. It is used as a gargle, and as an 
enema in chronic dysentery due to ulcerations in the lower end of the 
large intestine ; as an ointment for hemorrhoids and in certain irritable 
skin lesions, notably urticaria. 



KRAMERIA. — H^EMATOXYLON. 83 

KRAMBRIA. 

What points of interest does it present? 

Krameria, or rhatany, is the root of Krameria triandra and K. tomen- 
tosa, the cortical portion of which is most efficient. It contains rhatania- 
tannic acid, and has an astringent, slightly bitter, and sweetish taste. 
The dose of the powder is gr. xx-xxx. Its preparations are — 

Trochisci Kramerise, each containing gr. j. 

Extractum Kramerise, dose gr. v-xv. 

Extractum Kramerise Fluidum, dose wixx-3j. 

Syrupus Kramerise (i A. ext. ), dose 3j-iij. 

Tinctura Kramerise (20 per cent.), dose 3j-^ss. 

It is a favorite remedy in diarrhoea, especially the summer diarrhoea of 
children, and in dysentery, intestinal hemorrhages, etc. : it is adminis- 
tered by mouth, or, when the lesion is in the lower intestinal tract, by 
enema. 

CATECHU. 

Give its source, composition, and uses ? 

Catechu is an extract from the wood of Acacia catechu, a small East 
Indian tree. It is composed of catechu-tannic acid 50 per cent. , cate- 
chin, an extractive, 30 per cent., and other ingredients. Its uses are 
those of krameria, but it is more powerful from its larger percentage of 
tannic acid ; also used as an urethral injection in chronic urethritis. Like 
krameria, it is often employed in combination with other measures. Its 
officinal preparations are — 

Catechu (powdered), dose gr. x-3ss. 

Trochisci Catechu, in each gr. j. 

Tinctura Catechu Composita (contains cinnamon), dose 3ss-ij. 

KINO. 

What are its principal features? 

Kino is the inspissated juice of Pterocarpus marsupium, an East In- 
dian tree. It occurs in brittle, reddish-brown fragments, breaking in 
angular forms, and having a very astringent taste. It contains Mno- 
tannic acid. Tinctura Kino (10 percent.) is officinal, dose 3j-ij. Of 
the powder the dose is gr. x-xxx. It is a favorite remedy in intestinal 
hemorrhages and fluxes, and is employed as an injection in leucorrhoea, 
gonorrhoea, and gleet. 

HiEMATOXYLON. 
What is haematoxylon ? 

This drug, known also as logwood or Cam peachy-wood, is the heart- 
wood of Hctmatoxylon campechianum, a tree of tropical America. It 
contains tannic acid, hsematoxylin, hseniatein, which is used as a dye, 
etc. It is used for the same purposes as its sister remedies. The red 



84 ASTRINGENTS. 

color imparted to the stools may arouse suspicions of hemorrhage. It is 
particularly advocated in cholera infantum and the diarrhoea of phthisis 
(Biddle). It has an officinal extract, given in gr. x-xxx doses. 

GERANIUM. 

What are its source, composition, uses, and preparations? 

Geranium, crowsfoot or cranesbill, is the rhizome of Geranium macu- 
latum, an indigenous plant, containing tannic and gallic acids, gum, 
resin, starch, etc. It is an excellent astringent, well borne by the stom- 
ach, and can be substituted for the more expensive foreign drugs in any 
of their uses, as in enema, injection, gargle, or internally. Dose of the 
powder, gr. xx-xxx ; of the fluid extract, 3ss-j. 

HAMAMELIS. 

What is hamamelis or witch-hazel ? 

The leaves of Hamamelis virginica, an indigenous shrub : the bark 
may also be used. It contains from 8 to 10 per cent, of tannic acid and 
other principles. It is used as an astringent, and is thought by some to 
have haemostatic properties peculiar to itself. It is particularly useful 
in hemorrhoids, both locally and internally, and to fulfil any indication 
for tannic acid. It has an officinal fluid extract, dose 3ss-j. 

QTJEROUS ALBA. 

What is quercus alba? 

It is the inner bark of Quercus alba, or white oak, containing querci- 
tannic acid, tannic acid, etc. It is used as an astringent, and fulfils the 
indications of tannic acid. It has no officinal preparations, and a decoc- 
tion may be used. 

Enumerate other remedies of this class and their preparations. 

Rosa G-allica, petals of the red rose : 

Extractum Rosae Fluidum, 3j-ij. 

Confectio Rosae, j 

Mel Ilosae, > used as vehicles. 

Syrupus Ilosae, ) 

Rubus, the bark of the root of Rubus villosus and R. trivialis, or 
blackberry. Its officinal syrup is used as a vehicle. 

Castanea, chestnut, leaves of Castanea vesca, said to be an efficient 
antispasmodic in pertussis. 

Rhus Glabra, sumach, fruit of R. glabra, an indigenous shrub. 
Extractum Rhois Glabrae Fluidum is only used externally. 

Unofficinal vegetable astringents are — 

Heuchera, root of H. Americana, or alum-root. 

Statice Limonum, or marsh rosemary. 

Nymphsea Odorata, root of the sweet water-lily. 



ARGENTUM. 85 

These and many others contain tannic acid, and may be used in the 
form of a decoction. 

MINERAL ASTRINGENTS. 

What are they? 

Mineral astringents are a class of metallic salts having many actions 
and uses in common, but differing widely in other respects. As astrin- 
gents their uses correspond to those given above. 

ARGENTUM (SILVER). 

What are its preparations and their properties? 

Metallic silver is inert. 

Argenti Iodidum, dose gr. j-ij. 

Argenti Nitras, nitrate of silver, an anhydrous salt occurring in color- 
less rhombic crystals freely soluble in water. It has a metallic, astrin- 
gent taste, and gives a white precipitate, chloride of silver, with soluble 
chlorides^ dose gr. J— J. 

Argenti Nitras Fusus, external use. 

Argenti Nitras Dilutus, "mitigated stick," equal parts of silver and 
potassium nitrates ; external use. 

Argenti Oxidum, a brownish powder only slightly soluble in water ; 
dose gr. j. , 

Argenti Cyanidum, pharm. use. 

What are the incompatibles and antidotes of silver ? 

Silver salts are incompatible with hydrochloric, sulphuric, tartaric, and 
sulphurous acids and their salts ; with alkalies, alkaline carbonates, and 
astringent solutions. The antidote is common salt (sodium chloride) in 
large amounts in tepid water, which acts to form the insoluble silver 
chloride and as an emetic. 

What physiological effects are produced locally? What gener- 
ally? 

Locally, the nitrate of silver, which is the preparation most used, is a 
mild caustic, forming albuminate of silver and limiting its own action. 

Nervous System, — In small doses it is a tonic and antispasmodic; in 
large doses it causes headache, vertigo, loss of memory, nervous depres- 
sion, etc. by a centric action, and hypodermic-ally may paralyze. 

Circidation. — Heart not affected ; silver salts are absorbed into the 
blood as an albuminate ; the blood-corpuscles, after large doses, are said 
to be changed in shape and the haemoglobin to be converted to hsema- 
tin (?). The temperature as a result of these blood-changes is slightly 
lowered. Small doses increase the secretions of the gastro-intestinal tract 
and of the liver ; large doses or long-continued use causes catarrhal symp- 
toms, and may even result in erosions and ulcers of the stomach. 



86 ASTRINGENTS. 

What is meant by chronic argyria? 

This is a term applied to a train of symptoms following the prolonged 
use of the drug. Owing to its slow elimination by the kidneys and in- 
testines it becomes deposited in the tissues, and when this deposit is 
exposed to the light, as in the skin or mucous membranes, a slate or 
bluish color is developed. Parenchymatous or fatty degeneration of the 
liver and kidneys may also take place. The treatment of this condition 
consists in administering the iodide of potash to cause elimination, in 
baths of sodium hyposulphite, or in local applications of potassium cya- 
nide. These measures probably will fail. Prophylaxis is important. 
Never continue the use of silver salts more than six weeks at a time. 

What are the therapeutic uses of silver ? 

These are local and constitutional. Locally, the nitrate is used in 
acute tonsillitis in early stages; a strong solution (3ss to §j) mav abort 
or at least greatly alleviate. 

Ulcers of the mucous membranes, as of the mouth, tongue, cervix 
uteri, and endometrium, whether syphilitic or otherwise, may be benefited 
by strong solutions or the u stick.'' 

In indolent ulcers or sinuses as a stimulating application. In irritable 
ulcers the ' ' stick ' ' _ forms a protecting pellicle and relieves pain ; in 
vaginal gonorrhoea it may be used in strong solutions, but never in the 
male urethra ; in granular urethritis a deep injection of m,v to x of a 
gr. x to ^j solution may cure ; pruritus vulvas is cured by application of 
a solution (gr. xx to §j) to cervix, vagina, or external genitals, depend- 
ing on the seat of the cause of reflex excitement ; in conjunctivitis weak 
solutions (gr. j to §j) or the mitigated stick, if of granular variety. There 
is danger of deposits of silver salts on corneal ulcers, and consequent 
opacities ; hence zinc salts are preferable : cystic tumors, hydrocele, and 
interstitial thyroid tumors may be cured or diminished by the injection 
of ^ij-x of a 20-grain solution, first having withdrawn the fluid, if any. 

Internally, nitrate of silver is used in the later stages of cholera infan- 
tum as an astringent ; in the summer diarrhoea of children ; in chronic 
dysentery, either by mouth or by high enemata (gr. xx-xxx to water Oj ) ; 
in chronic diarrhoeas, as of tuberculosis, generally with opium ; in nervous 
dyspepsia and chronic gastritis in which gastralgia and symptoms of 
fermentation are prominent the oxide is recommended (Bartholow) ; in 
gastric ulcer the nitrate stimulates healing and relieves pain ; in epilepsy 
it is next to the bromides in efficacy, but has to be long continued, and 
may produce argyria ; in chorea as an antispasmodic it may improve ; 
the progress of locomotor ataxia may apparently be stayed. 

CUPRUM (COPPER). 

What are its preparations and their properties? 

Cupri Acetas, not used internally. 

Cupri Sulphas, blue vitriol or blue stone, dose gr. \ to v. 



ZINCUM. 87 

Copper Sulphate is obtained by roasting the native sulphide, and 
occurs as a by-product in silver-refining. It is in the form of prismatic 
blue crystals, efflorescing slightly and becoming covered by a white 
powder. It has a styptic taste and is freely soluble in water. 

Copper Acetate occurs in bluish-green rhombic prisms, and resembles 
the sulphate. 

What are its antagonists and antidotes? 

The alkalies, alkaline carbonates, mineral salts, iodides, and vegetable 
astringents are incompatible with copper salts. Acute poisoning is rare 
because of its own emetic action. The antidotes are albumin (white of 
egg, flour, etc.), forming an insoluble albuminate, or potassium ferro- 
cyanide, which forms copper ferrocyanide ; after the use of either the 
stomach should be emptied by the stomach-pump or an emetic. 

What physiological effects are produced? 

Metallic copper is inert. Locally, its salts are astringent and mildly 
caustic to mucous membranes and abraded surfaces. 

Nervous System. — In small doses it is a tonic, but in large doses causes 
headache, vertigo, inco-ordination, cramps, stupor, with perhaps convul- 
sions and paralysis. 

Circulation. — It probably exists m the blood as an albuminate; large 
doses are cardiac depressants. Poisonous closes give sjmiptoms of gastro- 
enteric irritation and collapse — viz. vomiting, abdominal cramps, diarrhoea 
with greenish or bloody stools^ (in chronic poisoning it resembles lead, 
causing cramps and constipation), coldness of skin, rapid and shallow 
breathing, cardiac depression, and any of the cerebral symptoms men- 
tioned above. Chronic poisoning may result from the inhalation of 
fumes in certain arts or from eating food cooked in copper vessels. The 
symptoms are those of bronchial or gastro-intestinal irritation, with or 
without cerebral symptoms. 

What are the uses of copper ? 

Locally, its sulphate may be used in indolent ulcers to stimulate gran- 
ulations ; in granular eyelids blue stone cures ; in gonorrhoea, after acute 
stage, as injection, gr. j to gj ; in scabies and tinea, as lotion or oint- 
ment. 

Internally, it is occasionally of service in chronic diarrhoeas and dysen- 
tery, gr. y^, combined with opium and gradually increased to gr. } : very 
efficient ; in vomiting of pregnancy, gr. ^, it acts as an antiemetic. In 
neuralgia, chorea, and epilepsy it is seldom used now. For its emetic 
action see Emetics. 

ZINCUM (ZINC). 

Metallic zinc is inert. Its salts act in a way analogous to, but much 
milder than, copper. 



88 ASTHINGENTS. 

What are its preparations ? 

Zinci Acetas. 

Zinci Carbonas Prsecipitatus, pharmacopoeial use. 
Zinci Chloridum, caustic. 
Liquor Zinci Chloridi (50 per cent, chloride). 
Zinci Iodidum, dose gr. ss-ij. 
Zinci Sulphas (white vitriol), dose gr. j-xx. 
Zinci Valerianae, dose gr. j-ij. 

Zinci Bromidum and Zinci Phosphidum are considered under Bro- 
mum and Phosphorus, respectively. 

With what are zinc salts incompatible ? What are the anti- 
dotes ? 

Zinc is incompatible with alkalies and alkaline carbonates, nitrate of 
silver, and vegetable astringents, all of which precipitate zinc salts. In 
poisoning, which only occurs after the more powerful salts, the milder 
being their own emetics, the proper antidotes are albumin, mucilaginous 
drinks, and opium. 

What physiological effects are produced ? 

The soluble salts (chloride, sulphate, and acetate) are readily absorbed, 
probably as albuminate, and are more active than the insoluble. Elimi- 
nation takes place by the secretions of the liver, intestines, and kidneys, 
and, although slow, is comparatively much more rapid than that of sil- 
ver, lead, or copper. Locally, they act by coagulating albumin, the 
chloride being a strong escharotic and disinfecting its own slough, the 
sulphate acting much more mildly, and solutions of proper strength as 
mild astringents. Acute poisoning is rare because of emetic action. 
Chronic poisoning may cause a train of symptoms similar to chronic 
plumbism — constipation, colic, muscular weakness, or multiple neuritis, 
but this too is rare. 

What therapeutic uses have the zinc salts? 

Zinc sulphate is used as an emetic. (See Emetics.) It is also used in 
bronchitis with profuse expectoration as a remote astringent ; in nervous 
disorders, as chorea, epilepsy, etc., as an antispasmodic and nervous 
tonic, but not so much as formerly. Locally, it is used as an astringent 
wash or injection in conjunctivitis, otorrhoea, and gonorrhoea in gr. j-vj 
to 3j solutions, and as a stimulant to sluggish granulations. 

Zinc acetate is used similarly to the sulphate, but weaker. 

Zinc chloride is a favorite escharotic for the destruction of lupus, epi- 
thelioma, malignant and indolent ulcers, and malignant growths gener- 
ally. It is commonly used with flour (1 to 3, 4, or 5 parts), and is known 
as Canquoin's paste. 

Zinc oxide is used internally in gastralgia, chronic diarrhoea, dysen- 
tery, etc. ; in night-sweats of phthisis as a remote astringent, gr. j-ij, com- 



PLUMBUM. 89 

bined with hyoscyamus or belladonna it is often very effectual ; in spas- 
modic asthma and whooping cough as an antispasmodic. 

Locally, as the officinal ointment or some of its modifications, it is of 
great value in eczema, erythema, impetigo, herpes, and other skin dis- 
orders. 

Zinc valerianate has met with success in hysterical headache, cough. 
or aphonia, and in neuralgia which is reflex from pelvic disorder. 

PLUMBUM (LEAD). 

What are the preparations of lead ? 

Metallic lead is not officinal. The officinal salts are — 

Plumbi Acetas, sugar of lead ; most used internally ; dose gr. ss-iij. 

Liquor Plumbi Subacetatis, Goulard's extract, 25 per cent. 

Liquor Plumbi Subacetatis Dilutus, 3 per cent. Liq. Plumb. Subacetat, 

Ceratum Plumbi Subacetatis, Goulard's cerate, contains Liq. Plumbi 
Subacetat. 20 per cent. , Ceratum Camphorse 80 per cent. 

Linimentum Plumbi Subacetatis, 40 per cent, in ol. gossypii. 

Plumbi Carbonas, white lead, chiefly used in Unguentum Plumbi Car- 
bonatis, which is 10 per cent. 

Plumbi Iodidum, dose gr. ss-iij. 

Plumbi Nitras, externally only. 

Plumbi Oxidum, litharge. 

Emplastrum Plumbi Oxidi contains one-third of the oxide in olive oil, 
and is the basis of most plasters. 

Unguentum Diachylon, externally, 60 per cent, of the above. 

What salt is most used internally? What are its preparation 
and properties? 
The acetate is most used. It is made by immersing litharge in crude 
acetic acid. It occurs in colorless efflorescent crystals freely soluble in 
water. 

What are its incompatibles ? 

The sulphate, carbonate, and iodide of lead are insoluble, and hence 
are chemically incompatible with solutions of sulphates, carbonates, car- 
bonic acid, or iodides ; also incompatible with albumin. 

What are the physiological effects of lead ? 

Locally, the soluble salts act as astringents and irritants and decrease 
secretions. They are absorbed as albuminates, like other metallic salts, 
and depress the circulation, lessening the force and frequency of the 
heart. They may act as remote astringents as well, checking hemorrhage 
and decreasing secretions, but this is denied by some authorities. 

What are its toxicology and treatment ? 

Toxic effects may take two forms, acute and chronic. Acute poisoning 



90 ASTRINGENTS. 

is rare, because of self-emesis, but may take place after large doses (,?j+) 
of the acetate. The symptoms are those of gastro-enteric irritation, with 
whitish vomiting (chloride) and black purging (sulphide). The proper 
remedies are the soluble sulphates (Epsom or Glauber salts or alum) and 
albumin to precipitate, followed by the use of the stomach-pump. 

Chronic poisoning or chronic plumbism, on the other hand, is quite 
common. It may result in various ways — in workers in lead, from water 
standing in lead pipes, etc. — and may take any of the following forms: 

Colica pictonum, or painter s colic, the characteristic symptoms of 
which are retracted abdomen, pains radiating from the umbilicus and 
supposed to be due to over-excitation of the intestinal ganglia, obstinate 
constipation, nausea, and vomiting. 

Lead arthralgia, a painful condition of the joints, supposed to be 
caused by deposition of urates in the joints from deficient oxidation. 

Lead encephalopathy, a rare form, characterized by delirium, convul- 
sions, coma, and death. 

Lead paralysis, a frequent variety of the disease. It is a peripheral 
neuritis, more often affecting the extensor than the flexor muscles, 
the upper than the lower extremity ("wrist-drop" or "toe-drop" are 
caused). 

A symptom which may accompany any of these forms of chronic 
poisoning, and is seen especially in uncleanly persons, is a blue or slate- 
colored line along the gums. Death may occur from malnutrition, 
paralysis of the respiratory muscles, or from coma. 

The treatment is prophylactic and eliminative. The former consists 
in the avoidance of any -source of contamination and by directing work- 
ers in lead to carefully clean their hands before meals. Sulphuric- acid 
lemonade and albumin (milk) are also to a degree prophylactic^ Elimi- 
nation is effected by the soluble sulphates mentioned above, iodide of 
potash, and sulphur baths. For the palsy galvanism is indicated, a 
peculiarity being that voluntary movement lasts longer than electrical 
excitability, and returns first. 

What therapeutic uses has lead acetate ? 

As mentioned above, lead acetate is almost solely used internally. It 
has been found useful in diarrhoea, dysentery, cholera, and yellow fever, 
acting by its local astringency ; in bronchitis and colliquative sweating, 
by virtue of its supposed remote astringency ; in aneurmn, from its 
combined sedative and astringent effects ; in hcematemesis from gastric 
ulcer ; valuable in haemoptysis ; probably one of the best remote 
haemostatics. 

Locally also the acetate is a favorite, although the oxide and carbonate 
are used, as in eczema and other irritative skin lesions ; in superficial in- 
flammations, as lead-and-opium wash, which, however, is not to be em- 
ployed as a collyrium ; in burns the lead solutions relieve pain, and white 
lead may be used over small areas. 



ALUMEN. — FERRUM. 9 1 

ALUMEN (ALUM). 
What is alum? 

The officinal alum is a double sulphate of aluminium and potassium : 
it is crystalline, slowly efflorescent, and soluble in water: when heated 
it gives up its water of crvtallization and is called "dried " or "burned 
alum." 

What are the preparations of aluminium ? 
Alumen, the above, or Potash Alum, dose gr. x-3ss. 
Alumen Exsiccatum, dried alum, ) 
Aluminii Hydras, > external use. 

Aluminii Sulphas, J 

What are the incompatibles of alum ? 

The alkalies and their carbonates, soluble lead salts, and tannic acid 
are the principal incompatibles. 

What are its physiological effects ? 

Alum acts locally as an astringent by causing coagulation of albumin, 
and in large doses as a g astro-intestinal irritant It is slowly absorbed, 
and is supposed to act as a remote astringent, causing contraction of 
the tissues and capillaries. 

Of what therapuetic use is alum ? 

Alum is used as a direct astringent in hcematemesis and intestinal 
hemorrhage due to passive congestion, no active inflammatory process 
being present ; in chronic dysentery and diarrhoea, generally in combina- 
tion. 

Locally, as an astringent to painful ulcers, hemorrhoids, or fasures ; 
in conjunctivitis as alum-whey, etc. ; in night-siceats, alum baths may 
check. 

For further use see Emetics. 

It is also believed by some to act as a remote astringent in bron- 
chorrhoea and hasmopt3 r sis, but inhalation of the vapor is preferable. 
It is a very efficient agent in lead colic, acting as a soluble sulphate and 
in some unknown way when there is no lead in the intestinal tract. 

The acetate of aluminium has recently found favor as a non-irritating 
antiseptic lotion in superficial inflammatory processes. 

TONICS. 

FERRUM (IRON). 

What are the relations of iron and anaemia ? 

Iron is an essential element in the haemoglobin of the red blood-cells, 
is thus a food, and is found to exist in small proportions in most food- 
products, especially beef. Whenever, from insufficient ingestion or as- 



90- TONICS. 

similation of iron or from its abnormal discharge or excretion, as in hem- 
orrhage, an insufficiency of this element occurs, a condition of anaemia is 
established. If in a patient in this condition the causes of deterioration 
be checked and iron be given, a rapid increase in the blood-elements 
takes place, and the patient returns to a healthy condition. In health 
its administration probably causes little effect. 

What can you say of the absorption, physiological effects, and 
elimination of iron ? 

The organic salts are absorbed directly into the blood, the acid radical 
being burned off (or oxidized), while salts of the mineral acids may be 
absorbed unchanged. Soluble preparations are probably converted into 
the chloride by the stomach acids. Iron probably exists in the blood as 
an albuminate, and is conjectured to act by converting the respired oxy- 
gen into ozone, a more efficient form for purposes of oxidation ; i. e. it 
is an adjuvant to the processes of oxidation in the body. The red blood- 
disks are increased in number and the haemoglobin in amount under its use. 

Secretions. — Iron preparations are astringent, decreasing the secretions 
generally, and especially the gastro-intestinal, thus causing constipation, 
with stools stained black by the sulphide. The urea, however, is in- 
creased as a result of increased tissue-metamorphosis. It is eliminated 
by the bile, urine, and feces, in the last named being probably that which 
has escaped absorption. 

What are the indications for the use of iron ? 

The main indication for the use of iron is ancemia. Many conditions 
dependent to a greater or less degree on anaemia are greatly benefited by 
the use of this blood tonic, especially neuralgia, hysteria, chorea, and 
occasionally epilepsy. Iron preparations are also used as stomachics and 
astringents : they should be administered on a full stomach. 

What are the most important preparations of iron ? 

The following preparations are important enough to require detailed 
notice : 

Ferrum Redactum (reduced iron), obtained by passing hydrogen gas 
through ferric hydrate : it is a tasteless, gray powder, insoluble in water, 
but very soluble in sulphuric acid, and very prone to oxidize ; it is a mild 
chalybeate of very slight astringency, and suitable for prolonged admin- 
istration in chlorosis, etc. ; dose gr. iij-vj. 

Ferri Oxidum Hydratum (ferric hydrate), prepared officinally by the 
reaction of ferric sulphate and ammonium hydrate : when dried it is not 
used medicinally, but, freshly precipitated as a moist reddish-brown 
magma, it is an antidote to arsenic. Given ad libitum for this purpose. 

Ferri Oxidum Hydratum cum Magnesia (ferric hydrate with magne- 
sia) : similar to the above preparation, but precipitated by magnesia in- 
stead of ammonia. From its slightly purgative action it is preferable as 
an antidote to arsenic. Dose ^ss or more, frequently repeated. 

Ferri Carbonas Saccharatus (saccharated ferrous carbonate), prepared 



FERRUM. 93 

by the double reaction of ferrous sulphate and sodium bicarbonate in the 
presence of sugar to prevent oxidation : a valuable preparation, as it 
retains its ozonizing power ; dose gr. v-xxx. 

Massa Ferri Carbonatis contains half its weight of ferrous carbonate : 
prepared as above. 

Ferri Sulphas (ferrous sulphate), when impure called green vitriol or 
copperas : prepared for medicinal purposes by dissolving iron in dilute 
sulphuric acid with heat ; occurs as greenish-blue crystals of styptic taste, 
and soluble in water ; in the air these effloresce, absorb oxygen, and be- 
come pale— viz. ferric sulphate is formed ; heated, they give up water 
of crystallization, and the dried sulphate is formed. It is an active 
chalybeate, but too astringent for continued use. Dose gr. j-v. 

Liquor Ferri Tersulphatis (solution of the tersulphate of iron) : very 
styptic ; employed to form the hydrate for arsenic-poisoning and locally 
as an astringent. 

Liquor Ferri Subsulphatis (Monsel's solution) is a solution of a basic 
ferric sulphate. It is useful as an internal astringent in gastric and in- 
testinal hemorrhage (dose Ttyy-xv), and topically applied it is one of the 
best styptics. In dilution it is a valuable application in inflammations 
of mucous membranes. 

Tinctura Ferri Chloridi (tincture of ferric chloride) is one of the most 
efficient iron salts, having a marked styptic taste and astringent effect, 
and in large doses causing irritation. It contains an ether to which it 
probably owes its slightly diuretic effect and its specific astringent effect 
on the genito-urinary tract. It is used with good effect in erysipelas, and 
has its advocates in diphtheria and scarlet fever. As it is particularly 
destructive to the teeth, care should be taken in prescribing it. Dose 
gtt. xv-xxx. 

Mistura Ferri et Ammonii Acetatis (Basham's mixture) is said to be 
very valuable in the ansemia of chronic nephritis. 

Syrupus Ferri Iodidi (syrup of the iodide of iron) is a transparent, 
pale-green liquid, combining the effects of iodine and iron, not consti- 
pating, and is a standard remedy in scrofulous or tuberculous conditions, 
especially in children ; dose gtt. x-xxx. 

Ferri et Potassii Tartras (iron and potassium tartras) occurs as trans- 
parent red crystals, wholly soluble in water, prepared by the addition of 
ferric hydrate to potassium bitartrate. Like the preceding preparation, 
it is non-constipating, which, with its agreeable flavor and its compati- 
bility with alkalies, renders it valuable for children. 

Ferri Pyrophosphas (ferric pyrophosphate) ; greenish scales, freely 
soluble in water : a valuable chalybeate ; dose gr. ij-x. 

Ferri Hypophosphis : supposed by some to be especially valuable in 
nervous lesions, generally in combination with other hypophosphites ; 
dose gr. x-xxx. 

Liquor Ferri Nitratis : in addition to its tonic action this is a good 
astringent, and as such is employed in intestinal and other fluxes when 
associated with anaemia. 



94 TONICS. 

Syrupus Ferri Bromidi (syrup of ferrous bromide) combines the action 
of iron and bromide, and is especially indicated in chorea with anaemia. 

Ferri et Quininae Citras (citrate of iron and quinine) : a valuable tonic, 
combining the effects of its two components ; dose gr. v-x. 

Vinum Ferri Amarum contains the above as its active ingredient, and 
is a good bitter tonic ; dose Sj-ij. 

Ferri et Ammonii Citras has antacid properties. 

Ferri et Ammonii Sulphas (ammonio-ferric alum) : used in chronic 
diarrhoea and dysentery for astringent effect. 

Ferrum Dialyzatum, a recently introduced and very valuable chalybeate : 
formed by the dialysis of a solution of ferric chloride. Its exact compo- 
sition is unknown. It should not be used in combination. It is only 
slightly constipating, and is a good antidote for arsenic. Dose gtt. x to 
xx, followed by sodium chloride to ensure its absorption. 

Other preparations of iron, all possessing tonic properties, are very 
numerous, but the foregoing seem ample for our purpose. 

MANGANUM (MANGANESE). 

What is manganese? 

The metal manganese is a normal constituent of the body, the blood, 
hair, etc. , existing in minute portions, and has tonic properties when ad- 
ministered alone or in combination with iron in conditions of anaemia 
and cachexia, but is inferior to iron. 

In what forms is it officinal? 

Mangani Oxidum Nigrum (black oxide or binoxide of manganese) : 
grayish-black, amorphous, or crystalline powder, odorless, tasteless, and 
insoluble in water ; dose gr. j-v. 

Mangani Sulphas (manganese sulphate) ; transparent, slightly rose- 
colored crystals, odorless, with a slightly styptic taste and soluble in 
water ; dose gr. j-iij. 

What are its uses? 

These salts are used as above indicated, as a succedaneum to iron. 
By some they are regarded as resembling bismuth, and are given in gas- 
trodynia and pyrosis : others attribute to them emmenagogue properties. 
The sulphate is thought to be cholagogue, and has been given in jaundice 
due to inflammation of the bile-ducts. Potassium permanganate is an 
antiseptic. 

ACIDUM SULPHURICUM (SULPHURIC ACID). 
What preparations are officinal ? 

Acidum Sulphuricum (oil of vitriol) contains 96 per cent, of the abso- 
lute acid ; is used externally as a caustic. 

Acidum Sulphuricum Dilutum: 10 per cent, strength in water; dose 
w^x-xxx : it is inferior medicinally to 



ACIDUM HYDROCHLORICUM. 95 

Acidum Sulphuricum Aromaticum, which is of 20 per cent, strength, 
with alcohol 7 per cent. , and tinct. zingiberis and oil of cinnamon. 

What effects does it produce? 

Sulphuric acid is a powerful penetrating caustic, abstracting the water 
from the tissues by its powerful affinity therefor, and carbonizing (black- 
ening) the flesh. Therapeutic doses of its weaker preparations - are ab- 
sorbed as sulphate, and eliminated in that form by the kidneys, intestinal 
tract, and skin, upon which tissues it exerts an astringent effect. 

What are its uses therapeutically? 

Locally, strong sulphuric acid is still somewhat used as a caustic in a 
paste with asbestos or charcoal in the treatment of chancroidal and other 
ulcerations. Diluted, and preferably as acid, sulphuric, aromat., it is 
used in diarrhoeas, especially the profuse watery forms, and also in cholera 
and cholera infantum ; also in the colliquative sweating of debilitated 
conditions ; in hemorrhages as a remote astringent, probably ineffective ; 
in lead-poisoning, in the acute form of which it is an efficient antidote, 
forming the insoluble lead sulphate; in chronic plumbism its efficacy 
is doubtful, but in the form of sulphuric-acid lemonade it may prove a 
prophylactic ; as a solvent for cinchona salts. 

In administering sulphuric acid care should be taken of the teeth, and 
it should be well diluted, for even the weaker preparations are irritating. 

What are the symptoms of toxic doses ? 

After a poisonous dose of the strong acid we have two stages : imme- 
diately pain in the oesophagus, throat, and epigastrium are experienced, 
followed by violent vomiting, often of tarry matter, with symptoms of 
severe collapse, death ensuing in from two to ten hours. If the patient 
survives this stage he suffers subsequently from ulcerations of the pha- 
rynx, larynx, oesophagus, and stomach, the parotids become inflamed 
from occlusion of Steno's duct, and an acute parenhymatous nephritis 
may develop. 

What are the diagnosis and treatment? 

The blackened slough makes the diagnosis. The treatment of the 
acute condition consists in the administration of the salts of magnesium 
and calcium or of the alkaline carbonates. Whitewash or soap may be 
the most available. The antidotes should be given freely in milk, water, 
or other diluent. Subsequent treatment is according to the nature of the 
sequelse. 

ACIDUM HYDROCHLORICUM (HYDROCHLORIC ACID). 

In what forms is it officinal? 

Acidum Hydrochloricum, 32 per cent, of gas ; not much used medi- 
cinally ; dose ^lv-x, well diluted. 



96 TONICS. 

Acidum Hydrochloricum Dilutum, 10 per cent, of gas; preferable 
form for stomach administration. 

What are its effects and uses? 

This drug exhibits neither pronounced caustic nor astringent effects. 
Being a normal stomach acid, and having a stimulating effect on the 
intestinal glandular system, its administration aids digestion by prolong- 
ing the action of the pepsin ferment. Thus it is^ useful in gastric dys- 
pepsia, and as the normal acidity of the stomach is not developed until 
at least half an hour after the ingestion of food, it should be given at 
a corresponding time, often in combination with pepsin. In intestinal 
dyspepsia combinations with nux vomica or some aromatic stomachic are 
valuable. These are the principal uses of this acid. The toxicology 
and treatment are the same as for other mineral acids. 

ACIDUM NITRICUM (NITRIC ACID). 

In what forms is it used? 

Acidum Nitricum contains about 70 per cent, of the absolute acid ; at 
first colorless, it changes on exposure to light to a yellowish color ; ex- 
ternal use only. 

Acidum Nitricum Dilutum, 16 per cent, strength, dose ttlxv-3j. 

What effects does it produce ? 

Locally, in strong solutions, nitric acid is a powerful chemical caustic, 
in weaker solutions an astringent stimulant. Internally, in considerable 
dilution, it stimulates the intestinal glandular apparatus, and has a local 
astringent effect, checking watery discharges. It is absorbed as the 
nitrate, but its method of elimination is unknown. 

What are its uses? 

Locally, it is used as a caustic in chancres, venereal warts, etc. , care 
being taken to protect the surrounding healthy tissues with vaseline, and 
to limit its action, when sufficient, by an alkaline lotion. Also used as 
caustic in cancrum oris and other phagedaenic conditions. Internally, 
nitric acid is used in dyspepsia, especially of the intestinal type, with 
torpidity of the liver ; and in serous diarrhoeas, in which Hope's camphor 
mixture is a good prescription. 

What is its toxicology? 

Nitric acid is a very powerful corrosive poison, causing deep, yellow 
sloughs, which are diagnostic. The symptoms and treatment are those 
of other mineral acids. 

ACIDUM NITRO-HYDROCHLORICUM. 

What is nitro-hydrochloric acid? 

This acid combination, known also as nitro-muriatic, consists of nitric 
acid 4 and hydrochloric acid 15 parts, forming an orange-colored, chlorine- 



ACIDUM LACTICUM. — PHOSPHORUS. 97 

evolving liquid, which changes on standing to a yellow color, in which 
condition it is directed to be used ; dose wiiij-v, well diluted. 

Acidum Nitro-hydrochloricum Dilutum contains the same amounts of 
the component acids, with water to 100 parts, and is thus about 20 per 
cent, strength ; dose ff\,xx-xxx. 

What are its physiological effects? 

The history of the drug after ingestion is not clear. Like the acids 
of which it is composed, it seems to be an intestinal glandular stimulant, 
with a special action on the hepatic secretion. 

What are its medicinal uses? 

This acid is used* in intestinal dyspepsia with hepatic congestion, the 
so-called "bilious" condition, and is very efficacious; in chronic diar- 
rhoea, especially in those cases due to imperfect digestion, with conse- 
quent irritations from undigested or fermenting food, acting by aiding 
digestion ; also in syphilitic dyscrasia and certain chronic skin diseases, 
in which it accomplishes good in the same manner. 

Locally, as baths (§iij-^v to Cij of water) or as a local application to 
the region of the liver (3j-iij to the pint) it is claimed to do good in 
chronic diseases of the liver, as cirrhosis, fatty liver, etc. Toxicology 
same as for other members of this group. 

ACIDUM LACTICUM. 

What preparations are officinal ? 
Acidum Lacticum, 75 per cent, of absolute acid, dose ttlv-xv. 
Acidum Lacticum Dilutum, dose fflxx-xl. 

What are its effects and uses? 

It exists as a normal acid in stomach digestion, and may be adminis- 
tered as an aid to the pepsin ferment in dyspepsia. 

PHOSPHORUS. 

What are its chemical properties ? 

Phosphorus is a non-metallic element, solid at ordinary temperatures, 
igniting at 100° F. and melting at 108° F. It is translucent, colorless 
when pure (generally slightly yellow), and has a peculiar garlicky odor. 
It is obtained from bone-ash (calcium phosphate) by removing the lime 
by sulphuric acid and dehydrating the residuum with charcoal. It is 
insoluble in water, only slightly soluble in oils, ether, and alcohol, and 
freely so in chloroform. 

What preparations have phosphorus effects? 

Phosphorus, never given in substance, dose gr. T ihr~8 1 o- 
Oleum Phosphoratum, 1 per cent, in ether and expressed oil of 
almonds, dose ^lj-iij. 
7— M. M. 



98 TONICS. 

Pilulae Phosphori, each contains gr. xoo« 

Zinci Phosphidum, dose gr. ^trru- 

Thompson's Solution of Phosphorus is not officinal, but is much used — 
3d = gr. -ft) ; dose accordingly. 

The various hypophosphites do not have the effects of phosphorus, and 
are considered later. 

What are the effects of phosphorus ? 

Locally, this drug is an irritant, producing inflammation, ulceration, 
and even gangrene. Constant inhalation by workmen having carious 
teeth may cause necrosis of the lower jaw. When taken internally it 
varies decidedly in its effects with the size of the dose. Medicinal doses 
stimulate the nervous system and act as a tonic thereto, repairing waste ; 
stimulate the circulation ; elevate and then slightly lower the tempera- 
ture ; and have a direct effect on bone-formation. Phosphorus is ab- 
sorbed in its own form, and is eliminated by the liver and general 
glandular system. 

What are the effects of toxic doses ? 

The symptoms develop tardily in from three to twelve hours. They 
are — general wretchedness, vomiting, at first of food, and bile with allia- 
ceous odor and luminous in the dark, later perhaps coffee-colored from 
exuded blood ; purging (the stools also being phosphorescent) and ab- 
dominal pain ; jaundice of the non-obstructive variety develops on the 
second day. Later, pronounced nervous disturbances occur — headache, 
giddiness, sleeplessness, somnolence, and coma : when these are marked a 
fatal termination may be expected. The urine is generally scanty and 
albuminous, and may contain glucose ; when jaundice comes on it reacts 
to the biliary acids and coloring matters. Death generally occurs not 
earlier than the second day, and may be postponed much longer ; it has 
resulted from gr. jss. 

What pathological changes occur in poisoning? 

The liver is enlarged, friable, and pale, with fatty degeneration of its pa- 
renchyma, followed in protracted cases by atrophy. The g astro-intestinal 
mucous membrane is swollen, opaque, and light-colored from a general 
adenitis, but is seldom eroded. The kidneys undergo changes analogous 
to those of the liver. The blood becomes dark, loses its power of coagu- 
lation, and ecchymoses occur in all parts of the body. 

Diagnosis of phosphorus-poisoning. 

The train of symptoms so closely resembles those of acute yellow 
atrophy of the liver that it may be impossible to differentiate. Phos- 
phorescence of the breath, vomited matter, and stools, and the primary 
enlargement of the liver may aid in diagnosis. 

How would you treat phosphorus-poisoning ? 

Avoid all fatty substances, which dissolve phosphorus and aid in its 



ACIDUM ARSENIOSUM. 99 

absorption ; give sulphate of copper as emetic, for it is also a chemical 
antidote by forming a black copper phosphide ; after thorough emesis 
the same drug may be given in small doses combined with opium as an 
antidote merely ; then give old French or acid oil of turpentine, which 
contains oxygen, the essential antidote. 

Of what therapeutic use is phosphorus ? 

Three classes of diseases call for the use of phosphor us— viz. diseases 
of bone-formation, of the nerves, and chronic affections of the super- 
ficial layers of the skin. Thus it is used in rickets and osteomalacia 
with markedly good results, generally in combination with iron ; in ner- 
vous exhaustion, neuralgia, cerebral softening, and myelitis it is used 
with advantage ; in acne indurata, psoriasis, the furuncular diathesis, 
and lupus it is a valuable succedaneum to arsenic. 

Points in its administration. 

The officinal oil of turpentine, being already in solution, is readily ab- 
sorbed, and should be used with care. The phosphide of zinc acts as a 
phosphorus compound, and although it is one-fourth phosphorus, only 
one-half of this is available. Hence the dose is eight times that of 
phosphorus (gr. ^o-tVX although Prof. Seguin gives as high as gr. 

ALTERATIVES. 

What are alteratives? 

This term has been applied to a class of drugs which have been found 
empirically to have a slow but certain effect in certain diseases or diath- 
eses, the rationale of their action being unknown. Their immediate 
effects in ordinary doses are slight, but in large or continued dosage they 
may depress very decidedly the nutrition and general condition of the 
body. 

ACIDUM ARSENIOSUM (ARSENIOUS ACID). 
What are its properties? 

Arsenic, or arsenious acid, when first sublimed from its ores occurs in 
glassy, colorless, transparent masses, which on keeping become milky- 
white externally. It is soluble in water, has a faintly sweetish taste, and 
volatilizes without fusing at a temperature of 400° F. or less. It is also 
called arsenious oxide or white arsenic. 

What are its preparations ? 

The metal arsencium is not officinal. TJie following are : 
Acidum Arseniosum, dose gr. -i^-\. ^* 

Liquor Acidi Arseniosi (1 per cent.), dose n\jj-viij. 
Arsenii Iodidum, dose gr. ^-t^. 
Sodii Arsenias, dose gr. YT~i- 



100 ALTERATIVES. 

Liquor Sodii Arseniatis (1 per cent.), erroneously called Pearson's 
solution, which is about gr. j to gj ; dose fflij-x. 

Liquor Potassii Arsenitis (Fowler's solution) contains of arsenious acid 
and sod. bicarb. 1 per cent, of each, and of tinct, lavand. comp. to color, 
3 per cent. Is most used. Dose nUj-yiij. 

Liquor Arsenii et Hydrargyri Iodidi (Donovan's solution) contains 1 
per cent, each of arsenious iodide and the red iodide of mercury ; dose 
tflv-x. 

What are its effects in therapeutic doses ? 

In moderate doses arsenic stimulates digestion and promotes nutrition. 
Aside from this, its effects are not obvious unless long continued, in 
which case dryness of the throat, nausea, perhaps diarrhoea, conjunctival 
and nasal irritation, and a peculiar facial oedema, especially noticeable 
beneath the eyes, may develop. The last is a signal for suspending the 
administration of the drug. This selective action on the mucous mem- 
branes takes place, however the drug be administered. _ If continued 
longer or in too large medicinal doses, a chronic poisoning with exag- 
geration of the symptoms supervenes, and digestive disorders, conjunc- 
tivitis, oedema, cutaneous eruptions with falling of the nails and hair, 
and local paralyses, may result. 

What are the symptoms, pathology, and treatment of arsenical 
poisoning ? 

The symptoms develop in from fifteen minutes to one hour : they are 
faucial constriction, burning pain in the oesophagus and stomach, suc- 
ceeded by violent spasmodic abdominal pain and persistent vomiting ; 
purging, the stools at first bilious, but later serous, with mucoid flakes 
and sometimes blood, excessive thirst, and suppression of urine, soon fol- 
low; then ensue collapse, with small feeble and rapid pulse, embarrassed 
breathing, coldness of the extremities and cyanosis, and finally death, 
preceded by coma. In some cases a remission of these symptoms occurs, 
but the urinary symptoms continue, and the above symptoms are again 
developed, with pronounced nervous symptoms, tremblings, cramps, and 
convulsions, skin eruptions, and finally a fatal termination in from two 
to six days. 

Sequelce. — In cases which recover there may be developed (1) inflam- 
matory conditions of the alimentary tract in any part; (2) a widespread 
multiple neuritis, the muscles presenting the reaction of degeneration 
and various sensory disturbances occurring; (3) in some cases perhaps 
an actual lesion of the spinal cord- (poliomyelitis) : the affected muscles 
generally recover. 

Lesions. — At the autopsy the gastro-intestinal mucous membrane is 
found swollen, congested, and in places covered by a plastic ( exudation, 
and, as the contents of the intestinal tract, a fluid resembling the dis- 
charges of cholera ; actual fatty degeneration of the liver, spleen, and 



HYDRARGYRUM. 101 

kidneys; in some cases congestion of the broncho- pulmonary mucous 
membrane has been noted. The tissues, and especially the nervous 
organs, are found to contain arsenic. (Indeed, during life, after elimi- 
nation of the drug has ceased, the administration of potassium iodide 
will cause it to reappear in the secretions. ) This storing of the drug in 
the tissues is true however administered, and diffusion may take place 
post-mortem. 

Treatment. — In recent cases immediate evacuation of the stomach, 
preferably by the stomach-pump, is indicated. One of the following 
antidotes should then be freely administered: (1) Freshly-precipitated 
ferric hydrate (q. v.), which forms an insoluble arseniate of iron; (2) 
ferri oxidum hydratum cum magnesia; (3) dialyzed iron, followed by 
common salt or some alkali. Demulcent drinks, opiates, and stimulants, 
p. r. n. , complete the treatment. 

What therapeutic uses has arsenic ? 

Locally, arsenious acid is a powerful caustic, and is used as such, either 
pure or mixed in varying proportions with sulphur, in the treatment of 
lupus, indolent sinuses, etc. The danger of absorption is said to be less 
when freely applied. Internally, it is much used in certain nervous con- 
ditions, as chorea, migraine, and neuralgia ; in chronic diseases of the 
superficial layers of the skin, as psoriasis, pityriasis, pemphigus, and 
certain chronic forms of eczema, but never until all acute symptoms are 
past ; in irritative dyspepsias, gastric ulcer, etc. small doses (TUj-ij of 
Fowler's solution) before meals ^ may relieve the symptoms and promote 
digestion ; ancemias, and especially the" pernicious form, may be greatly 
benefited — best combined with iron ; in malarial poisoning not yielding 
to quinine, and not in the acute stage, but only when paroxysms have 
ceased or become infrequent : it should be given in large doses ; multiple 
lymphadenomata and other glandular swellings have been known to 
recover under its use. 

What is its administration? 

The dosage will depend, as has been seen above, upon the condition to 
be reached. Thus, malarial poisoning and glandular enlargements will 
require considerable doses, while only small ones will be tolerated in cer- 
tain gastric conditions. The liq. sod. arseniat is said to be less irritating 
to the stomach, but Fowler's solution or the acid itself is the form most 
used. Donovan's solution will receive notice under Mercurial Prepa- 
rations. 

HYDRARGYRUM (MERCURY). 

What is mercury? 

Mercury, or quicksilver, is a volatile metal, liquid above —40° F. ^ ex- 
ceedingly heavy, but otherwise of negative properties. It is obtained 
from its native sulphide or cinnabar. 



102 ALTERATIVES. 

What preparations are in general use? 

Massa Hydrargyri (blue mass), one-third metallic mercury ; dose gr. 

j-x. 

Hydrargyrum cum Creta (gray powder) contains mercury 38 parts, 
creta prseparata 50, and lactose to 1 00 ; dose gr. v~3ss. 

Unguentum Hydrargyri (blue ointment), 50 per cent, mercury. 

Emplastrum Hydrarg. and Emplastrum Anmioniaci c. Hydrargyro 
are unimportant. 

Hydrargyri Chloridum Mite (calomel), dose gr. ss-xv. Calomel is an 
ingredient of the compound cathartic pill. Black wash (lotio nigra) is 
made by adding calomel Z] to lime-water Oj, the black oxide being 
formed. 

Hydrargyri Chloridum Corrosivum (corrosive sublimate), dose gr. 
sV-f- In yellow wash (lotio flaya) we have the yellow oxide of mercury, 
formed by adding 3ss of corrosive sublimate to Oj of lime-water. 

Hydrargyrum Ammoniatum (white precipitate) is contained in Unguen- 
tum Hydrargyri Ammoniati, 10 per cent. 

Hydrargyri Cyanidum, dose gr. ^o~h 

Hydrargyri Iodidum Rubrum. dose gr. ^-}. 

Liquor Hydrargyri et Arsenii Iodidum (Donovan's solution). 

Hydrargyri Iodidum Viride, dose gr. J-j. 

Liquor Hydrargyri Nitratis, a caustic. 

Unguentum Hydrarg}Ti Nitratis, citrine ointment. 

H\ T drargyri Oxidurn Flavum (yellow precipitate) is an ingredient of 
Unguentum Hydrargyri Oxidi Flavi, 10 per cent., and of Oleatum Hy- 
drargyri, 10 per cent. — a very useful preparation. 

Hydrargyri Oxidum Rubrum (red precipitate), used only in Unguen- 
tum Hydrargyri Oxidi Rubri, a 10 per cent, ointment. 

Hydrargyri Sulphidum Rubrum is cinnabar, dose 3ss. 

Hydrargyri Subsulphas Flavus (turpeth mineral) is an emetic. See 
Emetics. 

What are its physiological effects ? 

Mercury in its liquid state is inert, but workmen exposed to its vapors 
may develop salivation or mercurial palsy. Its compounds, however, 
are all active, and when locally applied produce effects varying from a 
very slight irritation to a violent causticity. Internally, single small doses 
cause very few symptoms beyond a slight stimulation of the secretions 
generally. Larger medicinal doses, continued, cause a train of symp- 
toms called salivation. The milder symptoms are tenderness and tume- 
faction of the gums, which bleed on the slightest abrasion ; soreness of 
the entire mouth, swelling of the tongue, and greatly increased secretion 
of the salivary and buccal glands, with a peculiarly foetid breath and 
strong metallic taste in the mouth. Swelling and inflammation of the 
salivary glands, a deep-red line along the gums, and in extreme cases 
falling of the teeth and necrosis of the maxillse, may occur. Added to 



IODUM. 103 

this- we may have a low fever, diarrhoea, neuralgia, nervous disorders, and 
a generally debilitated condition. The blood undergoes decided changes, 
its power of coagulation being lessened by a diminution of its fibrin and 
other solid portions. The nutrition of the body is lowered by large doses, 
but small ones probably have a tonic effect, at least in certain dyscrasige. 

Workers in mercury after long-continued inhalation of its vapor may 
become the victims of a mercurial tremor simulating paralysis agitans, 
or of a spasmodic condition resembling chorea. Other nervous symp- 
toms often accompany this, as loss of memory, vertigo, and at times 
local paralysis, probably due to a peripheral neuritis. 

The cathartic, emetic, and antiseptic effects of mercurial preparations 
will be considered under their respective headings. 

Elimination. — Mercury has been found in all the tissues and secretions. 
After its spontaneous elimination has ceased it may be renewed by the 
administration of potassium iodide, showing that it is stored somewhere 
in the tissues. 

What are its therapeutic uses? 

We will consider here the antiphlogistic and an ti syphilitic uses of the 
drug, leaving until later its other uses. By decreasing the fibrinous ele- 
ments of the blood, mercury may be useful in lessening plastic exudate 
in inflammations of the serous membranes, as pleurisy, peritonitis, peri- 
carditis, and iritis. Its value in endocarditis and pneumonia is less cer- 
tain. The pseudo-membranous forms of laryngitis are especially bene- 
fited. For this antiphlogistic effect it should be administered during the 
stage of exudation, and it is valueless in subacute inflammations. Calomel 
and the mass are the favorite forms. In syphilis its action is specific, 
and its administration should be begun at the earliest possible diagnosis, 
and continued during the secondary stage in dosage just sufficient to 
maintain a mild influence on the system. In the tertiary lesions it is in- 
dicated in combination with iodide of potash when an immediate effect 
is required on local lesions, as those of the brain or liver, which threaten 
life. Otherwise the iodide is used alone by most authorities. In the 
cachexia of syphilis it has been proven to increase the number of red 
blood-cells. As an antisyphilitic remedy mercury is employed in various 
ways — by mouth in the form of calomel or blue mass, by inunctions of 
the oleate or ointment, by fumigations of calomel, cinnabar, or the black 
oxide. In the later lesions the bichloride and the iodides are supposed 
to be especially efficacious as adjuvants to the iodide of potash. 

IODUM (IODINE). 

What are the properties of iodine? 

Iodine is a soft, friable substance, somewhat volatile at ordinary tem- 
peratures, of a chlorinous odor, melting at 225° F. , with the emission of 
a beautiful violet vapor. It is soluble in glycerin, alcohol, and ether, 
but practically insoluble in water. 



104 ALTERATIVES. 

What are the effects of continued and toxic doses ? 

Locally, it is a powerful irritant, and even a mild caustic. The tinc- 
ture stains the skin, causes a brief smarting sensation, and finally des- 
quamation. Medicinal doses produce a sensation of heat in the epigas- 
trium, a general increase of the secretions, with an especially marked effect 
on the mucous secretion of the respiratory tract and that of the salivary 
glands. If too long continued it gives rise to a train of symptoms known 
as iodism, as subacute gastro-enteritis, headache, giddiness, and other 
evidences of cerebro-spinal disorder, coryza, sore throat, frontal head- 
ache, salivation, a skin eruption, generally of acne, and sometimes 
atrophy of the manimse or testes. The circulatory effects are feeble, 
but it probably lessens vascular spasm, although perhaps not to a suf- 
ficient degree to render it of therapeutic importance. 

Taken in toxic doses, it produces the symptoms of violent gastro- 
enteric poisoning, with profound collapse and sometimes convulsions. 
Its injection into cavities has given rise to severe symptoms. Gr. xx 
are said to have caused death, while £>ij have been recovered from. The 
antidote is starch in any available form. 

How is iodine absorbed and eliminated? 

Iodine is readily absorbed, exists in the blood as sodium iodide, and is 
eliminated principally by the kidneys, but also in other secretions. 

What therapeutic uses has iodine ? 

Iodine is seldom used alone internally. With the iodide of potassium, 
as in Lugol's solution, it is employed as a resolvent in thyroid enlarge- 
ments and scrofula, in the latter of which, combined with iron and cod- 
liver oil, it is considered especially beneficial ; as an alterative in secondary 
and tertiary syphilis, but it is inferior to its potassium salt. 

Topically, the tinctures are favorite applications in glandular hyper- 
trophy, parasitic skin diseases, chronic painful joint affections, and as a 
counter-irritant in pleuritic and other pains. Deep injections have been 
employed with gratifying results in bronchocele, hydrocele, after aspira- 
tion of the contents with the purpose of producing adhesive inflamma- 
tion, and by some in phthisical cavities. 

POTASSII IODIDUM (IODIDE OF POTASSIUM). 
What are its chemical and physical properties? 

Potassium iodide is prepared by the addition of an excess of iodine to 
an aqueous solution of potassa, and the subsequent conversion of a con- 
taminating potassium iodate into potassium iodide by heating with char- 
coal. It is a white anhydrous salt, rather deliquescent in moist air, soluble 
grain for minim in water, and soluble also in alcohol. Its aqueous solu- 
tion dissolves iodine. (See LngoTs Solution, below.) 



POTASSII IODIDUM. 105 

What are its effects and uses? 

Its physiological effects are analogous to. but less energetic than, those 
of iodine. Locally, it is an irritant, and in large doses may cause gastro- 
intestinal irritation ; it increases the secretions, with the exception of 
that of the mammas, which it decreases. It is used in rheumatism, the 
subacute and muscular varieties being especially benefited by it. while in 
gout and rheumatoid arthritis it may be tried ; in neuralgias, especially 
the sciatic variety, which may be cured ; in asthma, given between the 
paroxysms, it seems to prevent their recurrence in some cases ; in chronic 
inflammations with serous accumulations, as chronic pleurisy or peri- 
carditis, it appears to promote absorption ; in aneurism it has a good 
reputation, but, being only slightly sedative to the circulation, its method 
of action is not clear; in chronic metallic poisoning, especially by lead 
or mercury, it is very efficient, forming soluble double salts with the 
metal deposited in the tissues, and thus aiding in their elimination. In 
the latter, if not used with care, it may cause serious salivation ; in 
tertiary syphilis, as in the osseous, visceral, or nervous lesions of that 
disease, it is our main reliance. 

It is also used as an antidote to poisoning by the alkaloids, with which 
it forms insoluble precipitates. 

How is potassium iodide best administered ? 

The ordinary dose is gr. x three times daily, to be gradually increased, 
but in lesions liable to cause fatal results, as in gummata of the brain or 
liver, much larger doses are given, up to §j-ij per diem. The saturated 
solution, which is practically grain for minim, is a convenient method for 
administering and increasing the dose. Given in milk or accompanied 
by small doses of Fowler's solution, it is less apt to cause acne, which is 
sometimes an unpleasant symptom. 

What are the preparations of iodine ? 

Iodum. 

Unguentum Iodi, 4 per cent. 

Ammonii Iodidum, dose gr. iij-x. 

Sodii Iodidum. close gr. v-xxx. 

Potassii Iodidum. dose gr. x-xxx or more. 

Unguentum Potassii Iodidi. 12 per cent. 

Liquor Iodi Compositus (Lugol's solution) contains iodine 5 and potas- 
sium iodide 10 parts in 100 ; dose u\,v-xv. 

Tinctura Iodi. 8 per cent. . chiefly for external use. 

Syrupus Acidi Hydriodici, 1 per cent, of the acid, dose fr^xx-xl. 

The iodides of zinc, silver, arsenic, and lead are officinal, and have 
been mentioned under the corresponding metals. 

Compare the other iodides with that of potassium. 

Hydriodic acid and the iodides of sodium and ammonium produce 
effects similar to potassium iodide, and may be substituted for it, but 



106 ALTERATIVES. 

they probably have no advantages, and the ammonium salt is more 
irritating. 

IODOPORMUM (IODOFORM). 
What is it ? 

Iodoform (formyl teriodide, CHI 3 ) occurs in yellowish scaly crystals, 
of disagreeable odor, insoluble in water, but freely soluble in alcohol, 
ether, chloroform, and oils. It contains 96 per cent, of iodine. 

What are its physiological effects? 

Topically, in powder or in strong solution, it produces considerable 
anaesthesia. It is readily absorbed from wounds, less readily from the 
gastro-intestinal tract. Large doses are depressant to the nervous, circu- 
latory, and respiratory functions. It is supposed to owe its activity to a 
liberation of iodine in the tissues. Elimination takes place slowly, for 
the most part in the urine. 

What can you say about its toxicology? 

When too freely applied to a large abraded surface poisoning may 
result. A variety of types of poisoning are recognized, as first pointed 
out by Schede. They are as follows : {I) febrile type ; (2) characterized 
by fever with gastro-intestinal irritations; (3) profound circulatory de- 
pression; (4) the same with fever; (5) immediate collapse and death; 
(6) meningeal type. Care should be taken not to confound this condi- 
tion with delirium tremens. The treatment consists in the immediate 
withdrawal of the drug, and stimulating and sustaining measures 
generally. 

What are its uses ? 

Iodoform is not much used internally. Locally, in surgical conditions, 
it has made itself indispensable, acting as an anaesthetic, stimidant, and 
antiseptic. The explanation of its efficacy in the latter direction is not 
clear, but probably it is only of value when decomposed by the ptomaines 
developed by the micro-organisms. In its own form it is not a germicide. 
It is used in all varieties of ulcers, especially if painful, in surgical 
wounds, and in painful rectal conditions, in gr. v-x suppositories : in 
tubercular conditions, such as tubercular laryngeal ulcers, its topical use 
is of value, while in cold abscesses its injection may prove curative. 
It is further used in a variety of surgical conditions too numerous to 
mention here. It has an officinal ointment. 

IODOLUM (IODOL). 

What can you say about iodol? 

Iodol is a brownish crystalline powder, resembling iodoform in its 
solubility, but differing from it in being odorless and tasteless. Its 
iodine percentage is stated by various authors at from 85 to 90 per cent. 
It is more slowly absorbed than iodoform, and hence less liable to cause 



ARISTOL.— OLEUM MORRHU^E. 107 

poisoning. It may be used locally as a pleasant substitute for this 
drug. 

ARISTOL. 
What is aristol? 

Aristol contains 45.8 per cent, of iodine: chemically it is dithymol- 
diodide ; not a germicide : it is non-irritating, and has been used locally 
in inflammations of the nose and upper air-passages, and in psoriasis, 
lupus, and syphilitic skin lesions. Its value is still sub judice. 

OLEUM MORRHUiE (COD-LIVER OIL). 

What are its source and composition ? 

Cod-liver oil is obtained from the liver of the Gadus morrhuce (common 
cod) and other species of Gadus. The "shore oil " as used in medicine 
is a yellow, thick oil, not rancid, and of a peculiar and to most people 
disagreeable odor and taste. Its composition is quite complex, the most 
important constituents being fatty acids, several biliary principles, gaduin 
(which is not an active principle), and traces of iodine, bromine, phos- 
phorus,^ and other substances. By the addition of ammonia, trimethyl- 
amine is formed. (See Ergot. ) Cod-liver oil is soluble in ether, chloro- 
form, and glycerin. 

What are its physiological effects? 

Like other fats, cod-liver oil is absorbed by the small intestine and 
acts as a nutrient, producing an increase of the body-weight ; its biliary 
ingredients probably aid in its absorption, but its effects are greater than 
those of other fats, and its complex nature probably gives it some alterative 
powers. Like other fats, it is difficult of digestion, and if the absorptive 
powers be overtaxed it may cause diarrhoea and other symptoms of 
digestive disorder. 

What are its therapeutic uses ? 

Cod-liver oil is looked upon as the most useful agent at hand in the 
treatment of tuberculous and scrofulous conditions. In the early stages 
of pulmonary tuberculosis it is an essential, and in some cases apparently 
curative, element of treatment. In all tuberculous manifestations, 
whether glandular, osseous, articular, or ulcerative, it is of value, but 
less so the more advanced the case and the older the patient. In con- 
ditions of ancemia or defective nutrition it is serviceable, especially in 
children ; thus in rickets this drug is of great value, and likewise in 
syphilitic cachexia ; and to this effect on the general nutrition may be 
attributed also its beneficent action in nervous affections, neuralgias, skin 
disorders, and chronic rheumatic conditions. 

How is it best administered ? 

Dose for a child one year old 3h f° r an adult ^ss or more three times 
daily. Various expedients are resorted to in order to disguise its taste. 



108 ALTERATIVES. 

Children, fortunately, soon learn to tolerate or even to like it, When 
after repeated trials it is not borne by the stomach, or when no gain in 
weight results, it is doing no good. 

ACIDUM PHOSPHORICUM AND ITS SALTS. 

Phosphoric acid has been used as an alterative in scrofulous affections 
and rachitis, but is inferior to its salts. It is used as acid, phosphoric, 
dilut., the dose of which is ^Ixv to 3j. 

CALCIUM PHOSPHATE. 

What are its effects and uses? 

This salts forms more than 50 per cent, of bone, and is also an essential 
part of the soft tissues ; a diet from which it is excluded causes sickness 
and death. Thus, its use is clearly indicated where there is deficiency 
of bone-formation, as is seen in rachitis and osteomalacia, and it has 
been found of value in delayed union after fracture, in caries, and in 
other diseased conditions of bone. It is also used in chronic phthisis 
tuberculosis generally, the anaemia of pregnancy, and certain syphilitic 
lesions, especially gummata and periostitis. 

Calcii Phosphas Prsecipitatus was recognized as officinal in the 
IT. S. P. of 1880, the dose of which is gr. x or more, t. i. d., but this, 
owing to its insolubility, is inferior to the lacto-phosphate of calcium, 
which is much used as an ingredient in emulsions of cod-liver oil. 

THE HYPOPHOSPHITES. 
What hypophosphites are in general use ? 

Those of calcium, potassium, sodium, and iron are officinal. They are 
seldom employed alone, but together in 

Syrupus Hypophosphitum, dose 3j-ij. 

Syrupus Hypophosphitum cum Ferro, dose 3j-ij. 

What are their uses ? 

These syrups, which have been imitated in many proprietary prepara- 
tions, are useful tonics, furnishing an easily oxidizable series of salts 
which may be readily converted into phosphates in the body. They do 
not represent the activity of phosphorus compounds. Like the phos- 
phates, they may be used in anaemia, rickets, mollities ossium, debilitated 
conditions generally, and tuberculosis, in the last of which the claim of 
curative action made for them is not now believed. 

SARSAPARILLA. 

What is sarsaparilla, and what are its effects and uses ? 

This drug is the root of Smilax officinalis and other varieties of Smilax. 
It has been considered to be diuretic, diaphoretic, and alterative, but 



GUIACUM. — ICHTHYOL. 109 

physiological experimentation has proven it practically inert. It is 
used principally as a vehicle for potassium iodide, in the form of syrupus 
sarsaparillse comp. , in syphilitic disorders. Its other preparations are not 
of importance. 

GUAIACI LIGNUM, GUAIACI RESINA. 

What is guaiac? 

These two forms of the drug are officinal. The wood is the heart- 
wood of Ghiaiacum officinale, a West Indian tree, containing the resin 
in the proportion of 60 per cent, or more. Guaiac is a very complex 
substance, but no satisfactory active principle has been discovered. 

What are its physiological effects and therapy ? 

Guaiac has a sialagogue effect from its acrid taste ; it also stimulates 
the hepatic (?) and intestinal secretions. It is absorbed and acts as a 
diaphoretic (?), expectorant, and alterative. Its continued use may cause 
gastro-enteric irritation. It is used in subacute and chronic rheumatism, 
in which it has a reputation ; in tonsillitis, which it may abort, but 
more often fails ; and is probably more successful in cases dependent on 
the ' ' rheumatic diathesis. ' ' It has been used in syphilis, but is of 
doubtful efficiency. 

Mention some other so-called alteratives. 

Mezereum, or mezereon, is the bark of Daphne Mezereon and other 
species of Daphne, shrubs of Northern Europe. It contains a crystal- 
line glucoside, daphnin, and a volatile acrid principle. It is decidedly 
irritant, and its chief use is as a stimulant to ulcers and to maintain 
issues. Internally, it has been used as an alterative combined with 
sarsaparilla. 

Sassafras, the bark of the root of Sassafras officinale, and Tar- 
axacum, the root of Dens leonis, or common dandelion, are believed 
to be .alterative, the latter also having a popular reputation as an hepatic 
stimulant. 

ICHTHYOL. 

In what forms does ichthyol occur ? 

Ichthyol is found in the shops as the ichthyo-sulphates of sodium and 
ammonium, both of which combine in all proportions with fats and vase- 
line. Ointments of 10 to 20 per cent, strength are most used. Both 
are soluble in water, the former having an alkaline, the latter a weak acid, 
reaction, and both a peculiar bituminous taste and smell. 

What are its effects and uses ? 

Locally, ichthyol is an irritant and a valuable stimulant to sluggish 
granulations. It is said to have a decidedly alterative effect on the 
skin and subjacent tissues. It is used in various skin affections, as chronic 
eczema, chronic urticaria, etc. ; in painful rheumatic, gouty, and trail- 



110 ALTERATIVES. 

matte joint conditions. In erysipelas, applied freely in one-half strength 
after thorough disinfection and covered with salicylated cotton, it is said 
to act very effectively and quickly. 

COLCHICTJM. 

What are its source and composition? 

Colchicwn autumnale, the seeds (colchici semen) and roots (colchici 
radix) of which are officinal, is a small plant of Europe. The so-called 
root is a eorm or bulb. Both parts have a bitter, acrid taste and contain 
an alkaloid, colchicine, soluble in both alcohol and water, upon which 
their activity undoubtedly depends. 

What preparations of the root are officinal ? Of the seeds ? 

Extractum Colchici Radicis (an acetic extract), dose gr. j-ij. 
Extractum Colchici Radicis Fluidum, dose ^ij-x. 
Vinum Colchici Radicis (40 per cent.), dose fflx-3j. 
Extractum Colchici Seminis Fluidum, dose w\jj-x. 

^S^fflSL^. 1 16 per cent., dose 3SS-JS, 



Vinum Colchici Seminis, 
What physiological effects does it produce? 

The effects of moderate medicinal doses of colchicum preparations 
are more or less gastric and enteric disturbance, as evidenced by ab- 
dominal uneasiness and pain, mild purgation, anorexia, and at times 
nausea, cardiac depression, and occasionally diaphoresis. A general 
stimulation of secretions takes place, but the effect upon the urinary 
solids is disputed, it being held by some that the elimination of urinary 
solids is increased, by others that it is unaffected. The flow of urine is 
generally increased. Excessive doses cause symptoms of irritant poison- 
ing, nausea, persistent vomiting, purging, occasionally bloody and severe 
abdominal pains ; convulsions may occur, and there is always profound 
cardiac depression. Consciousness is preserved to the last, and death 
takes place from exhaustion or cardiac paralysis. 

What is the toxicology of colchicum ? 

The smallest fatal dose is not clear. Of the wine of the root 3ijss 
and 3iijss have proved fatal. Enough has been said of the symptoms. 
The treatment consists in evacuation of the stomach and intestines, if 
this has not spontaneously taken place, and the administration of tannic 
acid as a chemical antidote, opium and demulcents in the later stages to 
allay irritation, and stimulation as necessity arises. 

What are the therapeutic uses of colchicum? 

The use of this drug is purely empirical, its therapeutic value having 
no clear connection with its physiological effects, so .far as these are known. 
In acute gout in sufficient doses to excite the skin, kidnej T s, and gastro- 
enteric tract, but with care in avoiding the production of vomiting and any 



CINCHONA. Ill 

pronounced diarrhoea (of the wine of the root, gtt. x-xx every four hours), 
it will diminish the pain and swelling and shorten the duration of the 
attack. In the intervals of the attacks, taken in smaller doses and less 
frequently, it is a good prophylactic, and is well combined with iodide of 
potassium. In subacute rheumatism and the so-called rheumatic gout 
colchicum in the same combination is very serviceable. In the constipa- 
tion and functional disturbances of the liver of the gouty diathesis com- 
binations of colchicum and salines are of value. 

ANTIPERIODICS. 
What are antiperiodics ? 

These are remedies which, by affecting the nutrition of the body or by 
a direct paralyzing effect on the malarial organism, check malarial par- 
oxysms. 

CINCHONA. 

What constitutes officinal cinchona? what is its habitat? 

The bark of any species of Cinchona containing S per cent or more of 
the officinal alkaloids is recognized as officinal, The original habitat of 
these trees was South America, but they have been successfully cultivated 
in India, Ceylon, the West Indies, and elsewhere. 

What are the important constituents of cinchona ? 

The alkaloids of cinchona are quinine, quinidine, cinchonine, and cin- 
chonidine, while two others, quinicine and cinchonicine, have been pro- 
duced artificially by heating quinine and cinchonine respectively, and are 
amorphous. Several other unimportant alkaloids have recently been dis- 
covered and more or less thoroughly investigated. Quinine and cincho- 
nine exist in combination with Jrinic acid. Cinchona also contains cincho- 
tannic and hinovic acids, starch, and a trace of a volatile oil. 

Name the varieties of bark. 

Cinchona Flava (Calisaya or yellow bark) contains a large proportion 
of quinine and very little cinchonine. 

Cinchona Rubra (the red bark) contains a considerable proportion of 
each. 

Pale bark and Carthagena or Columbian bark are weaker in alkaloids, 
but are used in their manufacture. 

Preparations and doses of cinchona and its alkaloids. 

Of the yellow bark the following preparations are officinal : 

Extractum Cinchonae, dose gr. v-x. 

Extractum Cinchonae Fluidum, dose tt\,v-x. 

Tinctura Cinchonae, 20 per cent., dose ^j— ij. 

Infusum Cinchonae, 6 per cent., dose §j-ij. 
Of the red bark only the following : 



- practically equal to the sulphate. 



dose from one-fourth to one-third greater 
than of the sulphate. 



112 ANTIPERIODICS. 

Tinctura Cinchonae Composita (Huxham's tincture), a 10 per cent, 
tincture, containing also bitter orange-peel and serpentaria, and consti- 
tuting a valuable tonic and antipyretic ; dose 3j~3 ss - 

The other preparations mentioned above are seldom used, the follow- 
ing alkaloids and their salts being preferred : 

Quinina. 

Quininae Sulphas, gr. j-xx. 

Quininae Bisulphas, 

Quininae Hydrobromas, 

Quininae Hydrochloras, 

Quininae Valerianas, 

Quinidinae Sulphas, 

Cinchonina, 

Cinchoninae Sulphas, 

Cinchonidinae Sulphas, 

What are the properties of quinine and cinchonine ? 

Quinine, either in an amorphous white powder or in the crystalline 
form, is without odor, very bitter, and practically insoluble in water (1600 
parts). Of its salts the bisulphate is most soluble, dissolving in 10 parts 
of water, the hydrobromate in 16, the hydrochlorate in 34, while the 
sulphate, the salt most frequently used, is again practically insoluble 
(740 parts), and hence is commonly given in pill, powder, or capsule. 
If a solution is desired, aromatic sulphuric acid dissolves the sulphate, 
grain for minim, and the bisulphate, gr. ij for minim, and these solutions 
may be administered in capsule. 

Cinchonine is a white crystalline substance, somewhat less bitter than 
quinine, but, like the latter, practically insoluble in water. It is also 
very insoluble in ether, and is thus separated from quinine, which is 
easily soluble in that menstruum. 

With what drugs is cinchona incompatible ? 

Its preparations are rendered insoluble by, and are therefore incompat- 
ible with, the alkalies and their carbonates, tannic acid, and iodine prepa- 
rations, while ferric salts precipitate their tannin and form ink. 

What physiological effects are produced? 

Locally, to mucous membranes and to surfaces denuded of their epi- 
dermis quinine and its salts are actively irritant. Internally, in sufficient 
dosage, the size of which varies greatly with the susceptibility of the 
individual, a train of symptoms called cinchonism is produced. The 
initial symptoms of this condition are tinnitus aurium, some deafness, 
and a sense of fulness in the head. After large doses these symptoms 
become more marked, and severe headache, disorders of vision, cutane- 
ous eruptions, giddiness and a staggering gait, delirium, and even collapse, 
may occur. 

Nervous System. — The symptoms produced by quinine would seem to 



CINCHONA. 113 

indicate cerebral congestion, but this has not been proved. # However 
this may be, the tinnitus aurium seems to be due to congestion of the 
middle ear. In animals the reflex excitability of the spinal cord is 
diminished or abolished, probably by stimulation of a centre supposed 
to preside over the reflexes and known as Setschenow's inhibitory 
centre. 

Circulation. — Large doses decrease the force and frequency of the 
heart's action by a direct action on its motor ganglia, while very large 
doses produce dilatation of the blood-vessels. Blood-changes occur ; the 
amoeboid activity of the white corpuscles is decidedly lessened and their 
number is diminished ; the red corpuscles are decreased in size, and the 
power of their haemoglobin to carry oxygen and ozone is impaired. 

Digestive Tract — Upon the stomach quinine acts as a simple bitter, 
increasing the appetite and digestive powers, but in very large doses it 
may prove irritant enough to produce nausea and vomiting. It is 
absorbed only by the stomach, the alkaline secretions of the intestinal 
tract precipitating it and preventing its absorption. 

Temperature. — In health the temperature is very slightly affected, but 
in fever it is lowered promptly and decidedly, probably from a diminished 
heat-production dependent upon lessened oxidation. 

Antiseptic Action. — The activity of the malarial plasmodia is 
lessened, or they actually disappear from the blood under its use. It 
also exerts a preventive influence upon putrefactive and allied pro- 
cesses. 

As has been already noted, quinine is an excito-motor, with a selective 
action upon the uterine muscle, but probably only acts after labor-pains 
have begun, and is incapable of originating them. 

How is quinine absorbed and eliminated ? 

As has already been stated, quinine is absorbed entirely, or for the 
most part, by the stomach. In the blood it is apparently held in solu- 
tion by the loosely-combined C0 2 present, and it is eliminated largely 
by the urine. 

What are its therapeutic uses? 

Malarial Conditions. — Quinine has been used in a great variety of 
conditions, but its greatest value has been found in these, for^ which it 
is in most cases a specific. In the regular intermittent type it may be 
used as a specific and prophylactic. There can be no doubt of its pro- 
phylactic value in doses of gr. ij, two or three times daily. Various 
methods of administration have found favor when the paroxysm has 
already occurred. Some advocate continued dosage of gr. v-x three 
times daily, but it is preferable to give it in frequently repeated small 
doses for twelve hours before the expected paroxysm or in large doses 
six and eight hours before that time. In any case it is well to continue 
its use for several days after the paroxysms have ceased, and to induce 
a slight degree of cinchonism on the seventh day, when a relapse is most 

8— M. M. 



114 ANTIPERIODICS. 

likely to take place. In severe malarial poisoning its efficiency is greatly 
increased by a mercurial purge. 

In the pernicious form no delay is permissible, and the patient should 
be cinchonized as rapidly as possible, it being necessary to give at least 
as high as 3ss-j during the day, and the hypodermic exhibition of the 
bisulphate is strongly urged. 

In a variety of conditions characterized by periodicity quinine is very 
valuable. Thus, neuralgias, chorea, hematuria, asthma, hay fever, and 
hiccough may in many cases be cured by quinine, although large doses 
may be necessary. In chorea and neuralgic headaches it is advisable to 
determine carefully the presence of any malarial taint before administer- 
ing this drug, for otherwise they may be made worse by its use. In 
the irregular and chronic forms of malaria its action is less certain, 
and it often fails. In bilious or remittent fever it may be given freely. 
In conditions of septic intoxication, septicaemia, pyaemia, and puerperal 
fever it has been much in vogue, but evidence of its utility is wanting. 
As an antipyretic in typhoid, typhus, and other continued fevers it will 
undoubtedly lower temperature, but has been largely superseded by the 
more recent antipyretics. As a stomachic tonic it is used in dyspepsia, 
especially of the fermentative varieties, while in debilitated conditions 
generally combinations of small doses (gr. j-ij) with iron are of great 
value. In fermentative diarrhoeas it may also do good. Acute coryza 
may be aborted by its use in some cases, and chronic bronchitis is often 
greatly benefited. 

Locally, quinine inhalations have been advocated in hay asthma and 
whooping cough, but have not made good the claims made for it. 

What are its administration and contraindications? 

Because of its extremely bitter taste quinine is best administered in 
freshly-prepared pills or in capsules. Hypodermically it is particularly 
efficient, and in pernicious forms of malaria may necessarily be so ad- 
ministered. It should be slightly acidulated by tartaric or other acids to 
prevent its immediate precipitation by the alkaline reaction of the blood. 

Quinine should be used with care when any gastro-enteric inflamma- 
tion obtains, and is absolutely contraindicated in inflammations of the 
middle ear. Cases of idiosyncrasy are not uncommon. Combinations 
with dilute hydrobromic acid or chloral are said to diminish the unpleasant 
subjective sensations of cinchonism. 

What are the properties, effects, and uses of quinidine ? 

Quinidinae sulphas, in which form alone this alkaloid is officinal, acts 
chemically like the sulphate of quinine, but exhibits different refractive 
qualities. It is weaker than quinine by about one-third, and its effects 
and uses are similar to those of its sister alkaloid. 

What are the effects and uses of cinchonine ? Of cinchonidine ? 

The sulphate of cinchonine is a bitter crystalline salt soluble in 54 



EUCALYPTUS. 115 

parts of water. As a tonic and antiperiodic it resembles quinine, but 
requires about one-third larger dosage. 

Cinchonidinae Sulphas. — Of the properties and powers of this 
salt too little is at present known. It seems a reliable substitute for 
quinine. 

What is chinoidinum ? 

This preparation, known as chinoidin or quinoidin, is a blackish resin- 
ous substance obtained by evaporating the mother-liquor from which the 
alkaloids have been obtained by crystallization. _ It is cheap and efficient 
according as it contains more or less of the active principles. 

What is Warburg's tincture ? and what are its uses ? 

Warburg's tincture is now prepared by modification of a very compli- 
cated formula, and owes its efficiency to aromatics and stimulants. It is 
much used as an antiperiodic in malarial fevers, and is said to be par- 
ticularly efficient in the severe and malignant forms, in which, after free 
purgation, it is given in two or three doses of §ss each before the 
expected paroxysm. It is a useful tonic in 3j doses three times a day. 

EUCALYPTUS. 

What are its source and composition? 

This drug is the leaves of Eucalyptus globulus, a tree native of Aus- 
tralia, but cultivated in other climates. It contains tannic acid, resin, 
and a volatile oil. the last of which is its active principle, is present in 
greater amount in the leaves, and has a pungent, aromatic odor and 
taste. 

What are the physiological effects of eucalyptus ? 

The effects of this drug are not clear. In large doses it produces 
some mental exhilaration, and excessive doses produce sensory disturb- 
ances, as numbness, sense of weight in limbs, etc., and some motor 
palsy, probably by paralysis of the spinal centres, as the peripheral 
nerves retain their irritability. Death is said to be caused in animals by 
paralysis of the respiratory centre. The oil (oleum eucalypti or euealyp- 
tol) is an antiseptic and more or less irritant, and possesses the general 
stimulant properties of the volatile oils. 

What are its uses? 

Eucalyptus is used empirically. It meets with success in mild mala- 
rial attacks, probably like other volatile oils, not as a specific, and is an 
excellent stimulant expectorant in acute and chronic bronchitis. The 
usual form for administration is the oil in doses of gtt, iij-v. Eucalyptol 
is also used with an idea to remote disinfection in offensive discharges 
of the broncho-pulmonary and genito-urinary passages. 

The cultivation of the trees is said to render malarial districts more 
inhabitable. 



116 ANTIPYRETICS. 



ANTIPYRETICS. 

Ant ip3 7 re tics are drugs which so modify nutrition as to lower febrile 
temperatures. 

ACIDUM SALICYLICUM (SALICYLIC ACID). 
What are its preparation and properties? 

Salicylic acid may be obtained from the methyl salicylate of oil of 
wintergreen or oil of birch. Most of it, however, is formed artificially by 
the combination of carbonic acid and phenol. It occurs as permanent, 
fine, needle-shaped crystals, odorless, tasteless or with a somewhat 
astringent after-taste, and an acid reaction. It is practically insoluble 
in cold water (450 parts), but freely so in alcohol, ether, and glycerin. 

What preparations contain salicylic acid? 

Acidum Salicylicum, dose gr. x-3j. 

Lithii Salicylas, dose gr. xx-xl. 

Sodii Salicylas, dose gr. xx-3j. 

Physostigminae Salicylas (see Physostigma), dose gr. ■£$. 

What are its physiological effects ? 

As might be inferred from its origin, salicylic acid resembles carbolic 
in its effects. Given in sufficient doses, it causes symptoms somewhat 
resembling cinchonism — tinnitus aurium and a feeling of fulness in the 
head, or, if more pronounced, deafness, ptosis, strabismus, partial 
blindness, and excessive sweating. In cases of poisoning, ptosis, rest- 
lessness, and severe headache, delirium, either wild or of a melancholic 
type, olive-green urine, and slow and labored respiration occur, ending in 
collapse and death. 

Nervous System. — Ordinarily the cerebral symptoms produced re- 
semble those of quinina, and the delirium is not marked : whether they 
are due to congestion or anaemia is not clear. 

Circulation. — Authorities differ about the cardiac effects of this drug, 
but in medicinal doses it has little or no depressing effect upon the cir- 
culation. It is claimed that excessive doses produce slow and labored 
pulse. In the blood it has been proved to have a depressing effect on 
the activity and emigration of the white blood-corpuscles. 

Respiration is at first stimulated, later depressed. 

Temperature. — In health this function is not affected by moderate 
doses, but in febrile conditions in large doses it produces a considerable 
fall of temperature, which is preceded or accompanied by profuse sweat- 
ing. To obtain this effect large doses (3j) must be given. Continued 
administration may cause gastric disturbance. 

How is it absorbed and eliminated? 

Salicylic acid is probably absorbed as an alkaline (sodium) salicylate. 



SALICINUM. 117 

It is eliminated chiefly by the urine in its own form or as salicyluric acid. 
The absorption is rapid, the acid appearing in the urine in from eight to 
ten minutes, but the elimination is slow. The urine is colored green by 
an increase of the indican, and after excessive doses may be albuminous 
from renal irritation. The antiseptic effects of salicylic acid will be con- 
sidered elsewhere. 

What are the therapeutic uses of salicylic acid ? 

The great field for salicylic acid at present is in the treatment of acute 
articular rheumatism. Given in doses of gr. x-xv every two or three 
hours, it reduces the temperature, relieves the pain, and greatly shortens 
the painful part of the attack ; but there is doubt as to its efficacy in 
preventing relapses and cardiac complications ; in fact, most authorities 
are veering to the belief that it does not. It is advantageously combined 
with alkalies, and more than enough bicarbonate of soda to neutralize it is 
generally prescribed (about 6 parts of the alkali to 10 parts of the acid). 

In gonorrhoea! and subacute rheumatism it is less efficient, but often 
proves valuable, while in lumbago and myalgia generally, and in chronic 
rheumatism and gout, it is often serviceable. In acute tonsillitis, espe- 
cially in those cases which seem to depend upon a rheumatic diathesis, it 
is often of signal service in small, frequently-repeated doses. Rheumatic 
iritis has been reported cured by its use. In typhoid and other continued 
fevers and in the exanthemata it is now seldom used as an antipyretic. 
As it does not destroy the spirillum of relapsing or the Plasmodium of 
malarial fever, it can in no sense be considered a specific in these condi- 
tions, but may do good by abating certain symptoms, especially the fever, 
although we now have better antipyretics. 

SALICINUM (SALICIN). 

Salicin is a glucoside obtained from Salix helix and other varieties of 
Salix. It occurs in permanent, odorless, prismatic crystals of bitter 
taste, and is soluble in 28 parts of water and 30 of alcohol, and insoluble in 
ether and chloroform. Hence it is generally given in capsules, wafers, 
or pills, or in mixtures. 

What are its effects and uses? 

The effects of salicin are not pronounced. Compared to salicylic acid, 
it is less irritant to the stomach, and perhaps less apt to cause unpleasant 
head-symptoms, and it is free from toxic effects. Part of it at least is 
converted into salicylic acid in the blood. It is useful in acute rheuma- 
tism, accomplishing the same results as salicylic acid, but acting much 
more slowly. When the latter drug causes gastric irritation or cerebral 
symptoms, this will prove a very efficient substitute in doses of gr. xv-xx 
every two or three hours. It is also used as a bitter tonic, as an anti- 
fermentative in diarrhoeas, and occasionally as an antiperiodic. 



118 ANTIPYRETICS. 

OLEUM aAULTHBRIJB. 

What are its source and physical properties? 

Oil of gaultheria is a very volatile, slightly yellowish liquid, derived 
from Gaultheria procumbens. It has a peculiar penetrating odor, and 
consists of 90 per cent, methyl salicylate. Its salicylate strength is five- 
sixths that of salicylic acid, and the dose should be proportionately 
larger. 

What are its physiological effects? 

These are identical with those of salicylic acid, and it forms in capsules 
or in mixtures a reliable and easy method of administering the salicylates 
in acute rheumatism, the usual dosage being about 150 drops daily in 
frequently repeated doses. Oil of birch is often substituted for it, and 
is equally or even more efficient. The odor of the oil appears in the 
urine under its use, and this secretion decomposes less rapidly. Hence 
the oil is used with a view of asepticizing the genito-urinary tract. 

SALOLTJM (SALOL). 

What are its derivation and properties? 

Salol is salicylate of phenol, or salicylic acid in which 1 atom of H has 
been replaced by phenol. It is a white crystalline powder, with a slight 
odor of oil of wintergreen, tasteless, nearly insoluble in water, but solu- 
ble in alcohol and ether. 

What effects does salol produce? 

Salol is not dissolved in the stomach, but in the alkaline secretion of 
the intestinal tract it is slowly broken up into its 'two component parts, 
yielding 36 parts of carbolic and 64 parts of salicylic acid. In its effects 
it more closely resembles salicylic acid, producing ringing in the ears and 
other constitutional symptoms of that drug, but to a less degree and with 
almost no gastric disturbance, as it is not dissolved in the stomach. 
After large amounts the urine has a smoky color of carbolic-acid poison- 
ing. 

What are its therapeutic uses? 

It is a good disinfectant, and is used as such in the various forms of 
stomatitis and pharyngitis, while its similarity to salicylic acid renders it 
a valuable substitute for that drug in acute rheumatism and as an anti- 
pyretic. It is used also to render the urine aseptic in cystitis, and at one 
time was in favor as an intestinal antiseptic in typhoid fever and cholera. 
It can be useful in these conditions only by preventing the development 
of bacteria, as its dilution must be far too great for any actual germicidal 
effect ; and even in strong solutions its germicidal powers are so weak as 
to render it probably inert in these conditions. Its value is still sub 
judice. Owing to its insolubility in the stomach, it may be used as a 
test of the peristaltic activity of that organ or of the presence of pyloric 



BETOL, OR NAPHTHOLOL. — ACIDUM CARBOLICUM. 119 

obstruction. When the stomach is healthy the urine should show the 
presence of salicyluric acid in from one-half to three-quarters of an hour, 
and if its appearance be delayed beyond an hour a pathological condition 
is probable. 

How is salol prescribed? 

Salol is generally given in pill or capsule, the dose being gr. v-x, re- 
peated rather frequently. When its local action is desired in the mouth 
or pharynx, tablets slowly dissolved in the mouth are useful. 

BETOL, OR NAPHTHOLOL. 

What are its chemical and physical properties? 

Betol is another of the same series, and is analogous in composition to 
salol, the difference consisting in the substitution of beta-naphthol instead 
of phenol for the H atom. It occurs in small whitish crystals, insoluble 
in water, but soluble in alcohol and fats, and having a high melting-point. 

What are its physiological history and uses ? 

Like salol, it passes undissolved and unabsorbed through the stomach, 
is converted into its component parts by the pancreatic secretion, and acts 
as salicylic acid, of which it yields about 55 per cent. It is entirely non- 
toxic. Of its antiseptic properties and therapeutic uses the same may 
be said as of salol, but, owing to its lesser percentage of the acid, it is 
probably not as efficient. 

ACIDUM CARBOLICUM (CARBOLIC ACID). 

What is carbolic acid ? What are its synonyms and method of 
preparation ? 

Although this drug finds use chiefly as an antiseptic, yet its physio- 
logical effects and chemical composition demand for it notice in this con- 
nection . Carbolic acid, known also as phenol, phenic acid, phenyl hydrate, 
and phenyl alcohol, is a coal-tar derivative. It is formed by adding a 
hot concentrated solution of potash to crude coal-tar, and then water, 
when it is converted into a light oil and a heavier alkaline liquid, which 
latter is neutralized by hydrochloric acid, when crude carbolic acid " sepa- 
rates out. " In this form it contains several analogous substances, chiefly 
xylic and cresylic acids, which possess very similar properties to itself. 

What are its characteristics? 

When pure, carbolic acid is colorless, solid at ordinary temperatures, 
crystallizes at ordinary temperatures, and has a characteristic odor and 
burning taste. Pure acid, however, is hard to obtain, and it generally 
presents a slight pinkish tinge on standing. These impurities, however, 
do not affect its efficacy, some even holding that its contaminating acids 
are more powerful than carbolic acid itself. It is soluble in 20 parts of 
water (5 per cent, solution), and freely so in alcohol, ether, glycerin, and 



120 ANTIPYRETICS. 

the fixed and volatile oils, and deliquesces without dissolving when exposed 
to moist atmospheres. It is neutral in reaction, but combines with sali- 
fiable bases. 

What are its physiological effects ? 

Locally, phenol is a 43rotoplasmic poison, destroying all organic tissues. 
It produces more or less anaesthesia, not only of the parts with which it 
comes in immediate contact, but also of the underlying tissues, and in its 
pure state produces white eschars followed by a superficial gangrene. 

Absorption and Elimination. — Carbolic acid is probably absorbed, and 
exists in the blood as an alkaline carbolate. It is eliminated by all the 
secretions as an alkaline carbolate, as well as certain products of its oxi- 
dation when small amounts are ingested, but mostly unchanged after 
large doses. 

Nervous System. — Poisonous doses produce in man vertigo, contracted 
pupils, and tremors, while in animals convulsions, apparently of spinal 
origin, and paralyses, occur. 

Circulation. — The heart is at first slowed and then accelerated (by 
stimulation and subsequent exhaustion of the vagi(?)); the arterial pres- 
sure is at an early period lowered by paralysis of the vaso-motor centre 
in the medulla ; and the movements of the white blood-corpuscles are 
rendered more sluggish. 

The respiration is rendered rapid and shallow by large doses, and some 
reduction of temperature takes place. The urine derives a dark-brown 
color from the oxidation products, and as this smoky color gives the first 
warning of poisoning by either its external or internal use, the urine 
should be carefully watched and the drug withdrawn upon its earliest 
appearance. 

What are its symptoms, diagnosis, treatment, and post-mortem 
appearances ? 

The poisoning may be slow or rapid. In the slow variety, which occurs 
from absorption after operations or dressings, the symptoms are smoky 
and albuminous urine, great feebleness and collapse, diminished circula- 
tory and respiratory power, muscular weakness, and giddiness. In the 
rapid form, occurring after the ingestion of a concentrated fatal dose, the 
symptoms are impairment of sensation and motion, unconsciousness, 
stertor, feeble and frequent pulse, collapse, tremors, and death. _ If the 
patient lives long enough, symptoms of gas tro- enteric irritation may 
develop. 

The diagnostic signs are the characteristic odor of the breath, whitened 
patches on the visible mucous membranes, and discolored urine. 

The treatment consists in the evacuation of the stomach by the stom- 
ach-pump, and the administration of some soluble sulphate, as the sul- 
phate of magnesium or sodium or dilute sulphuric acid. These form 
the comparatively harmless sulphocarbolates. Free hypodermic stimula- 



SODII STJLPHO-CAKBOLAS. 121 

tion with ammonia, ether, or alcohol, and demulcent drinks during the 
later stages, complete the treatment. 

Appearances Post-mortem. — After the ingestion of a fatal dose of the 
concentrated acid hard white areas of necrotic tissue, surrounded by 
zones of inflammation, are found wherever the acid has been in contact ; 
the hollow viscera are filled with imperfectly coagulated blood, and the 
liver and kidneys sometimes show fatty degeneration. 

What are the preparations of carbolic acid? 
Acidum Carbolicum, dose gr. j-iij. 
Unguentum Acidi Carbolici, 10 per cent. 
Acidum Carbolicum Crudum, for disinfecting purposes. 

What therapeutic uses does carbolic acid fulfil? 

Internally, carbolic acid is employed for its local effects in nervous vom- 
iting and gastrodynia. which are alleviated by the anaesthesia produced 
— gr. j-ij doses repeated frequently ; in diarrhoeas, especially of the irri- 
tative and fermentative varieties — generally combined with bismuth ; in 
gangrene of the lung, which is said to be much benefited by its combined 
use internally and by inhalation. 

Locally, the pure acid may be used as a caustic where extensive action 
is not desirable, as in condylomata, diphtheritic conditions, etc. ; in weaker 
solutions it is a favorite ingredient in gargles and sprays. Burns and 
painful or itching ulcers may be relieved by its weak dilutions in oily 
menstrua (gr. x-xv to ^j of petrolatum, etc.). Injections of 2 per cent, 
solutions into inflamed serous cavities, as in synovitis, have been employed 
with good effect, while the injection of a few drops of the pure acid into 
the tunica vaginalis after aspiration of the contents of a hydrocele is one 
of the best methods of radical cure. The use of carbolic acid as an anti- 
septic will be mentioned later. 

SODII SULPHO-CARBOLAS (SULPHOCARBOLATE OF 

SODIUM). 

This salt, which we have seen is the harmless result of administering 
soluble sulphates in carbolic-acid poisoning, is a colorless, transparent 
salt, permanent in the atmosphere, soluble in 5 parts of water and also 
in glycerin and alcohol. The corresponding salts of magnesium, potas- 
sium, and calcium are also employed. 

What are the effects and uses of the last-named salts ? 

They possess weaker antiseptic properties than carbolic acid, but from 
their non-toxic effects are employed to fulfil many of the indications for 
which that drug is used. Thus, they are valuable in gastric and intes- 
tinal disorders, vomiting and flatulence being especially benefited, and as 
topical applications in inflammations of the mouth, nose, and pharynx. 



122 ANTIPYRETICS. 

CREOSOTUM (CREOSOTE). 

What are its origin, method of preparation, and composition ? 

Creosote is obtained as a product of the dry distillation of wood-tar 
or from crude pyroligneous acid. It is a colorless, oily liquid, turning 
dark on exposure, and having a peculiar smoky odor, burning taste, and 
neutral reaction. It is soluble in 80 parts of water, and in all propor- 
tions in alcohol, ether, chloroform, benzine, and acetic acid. In compo- 
sition it is very complex, containing phenol, cresilol, creasol, and other 
substances of the hydrocarbon series. The pure drug is difficult to 
obtain, and crude phenol is often substituted for it — a sophistication 
which can be detected by its solubility in commercial glycerin, while 
creosote is not. 

What are its effects and uses ? v 

Creosote possesses many qualities in common with carbolic acid. The 
symptoms of poisoning and the proper antidotes are the same as for 
that drug. It is eliminated by the kidneys and the bronchial mucous 
membrane, upon the latter of which it acts as a stimulant expectorant. 

Its uses also correspond to those of carbolic acid, but it is more used 
to allay vomiting and gastralgia, and is a good astringent antiseptic in 
diarrhoeas. It is at present used in pulmonary tuberculosis, and, com- 
bined with proper hygienic measures, may cure in the early stages. 
Locally, it is used in varying degrees of dilution as a dressing for foul- 
smelling and indolent ulcers and in irritative skin diseases, and as a gargle 
in putrid sore throat. In dentistry it is much used as an analgesic in 
toothache. 

How is it administered? 

The dose for internal administration is gtt. ss-ij, and should be taken 
frequently. 

Aqua Creosoti, a 1 per cent, solution, is a convenient form of admin* 
istration. This preparation may be used externally as a disinfectant and 
to allay itching, but carbolic acid is more used, because less expensive. 

CREOLIN, KREOLIN. 
What is creolin? 

This drug, a recent importation, proprietary and not yet in general 
use, is a derivative of coal-tar. Its specimens vary in composition, some 
being soluble in water, while others form emulsions. It is a dark-brown, 
syrupy liquid, of tarry odor and somewhat biting taste. 

What are the effects and uses of creolin ? 

Creolin is an antiseptic, and is said to be more powerful against non- 
spore-bearing than against spore-bearing organisms. It is absolutely in- 
nocuous to man. It is used in 1 to 2 per cent, solutions, and is a stimulant 
to indolent granulations. Solutions of 1 per cent, strength are useful 



THYMOL. RESORCIN. 1 23 

substitutes for dressings of carbolic acid or bichloride of mercury when 
these prove irritant to the skin. 

THYMOL. 
What are its source and properties? 

Thymol {cymylic, phenol, or thymic acid) is a crystalline solid, or occa- 
sionally a liquid, obtained from oil of thyme (oleum thymi) by fractional 
distillation. Oil of thyme is a volatile oil derived from Thymus vulgaris 
and other plants. Thymol is soluble in 1200 parts of water, and freely 
so in alcohol, ether, chloroform, and oils, and has a peculiar odor which 
to some individuals is unpleasant, and which in summer attracts flies. 

What are its effects and uses ? 

Thymol is a strong antiseptic, ranking just above carbolic acid in power, 
and resembling it in producing cutaneous anaesthesia. Taken by mouth, 
it causes tinnitus aurium, partial deafness, some reduction of temperature, 
with at times nausea, vomiting, and diarrhoea. Although less toxic 
than carbolic acid, large doses may cause violent delirium and collapse, 
accompanied by profuse sweating and a dark-green coloration of the 
urine. It may be used to fulfil the indications for carbolic acid, but is 
expensive and little used. As an antiseptic mouth- wash in aphthous 
stomatitis it is particularly valuable, and in 1 : 1000 solutions (made with 
alcohol) it is a good antiseptic and non-irritating to the skin. 

RESORCIN. 

What are its source and properties ? 

Resorcin is a substance first obtained from the resins of galbanum 
and asafoetida, but now derived from phenol, to which it is closely 
related chemically. It is crystalline, colorless at first, but becomes 
reddish on exposure, and is freely soluble in water, alcohol, and ether. 

What physiological effects are produced? 

In doses of gr. xx to xl resorcin causes giddiness, tinnitus aurium, pro- 
fuse diaphoresis, and reduction of temperature, the last, however, not- 
being constant and of uncertain duration. After poisonous doses cerebral 
and sensory disturbances, unconsciousness, convulsions, and collapse may 
follow. 

For what conditions is it employed? 

This drug is now seldom used as an antipyretic, being uncertain and 
unsafe in the dosage required to produce such effects. It is employed 
as an antifermentative and analgesic in gastric ulcer, gastralgia, and 
diarrhoeal disorders : as a spray-inhalation it is of reputed efficiency in 
pertussis and hay asthma. 

Externally, it may be employed in the same surgical conditions as 
carbolic acicl, to which it is preferable because of the lesser danger of 



124 ANTIPYRETICS. 

toxic effects and its freer solubility in water. It has been particularly 
recommended in erysipelas, cystitis, chronic otitis, and leucorrhcea. For 
antiseptic purposes solutions of from 1 to 5 per cent, are used. Oint- 
ments of from 5 to 10 per cent, are also used for a variety of skin 

diseases. 

BENZOINUM (BENZOIN.) 
ACIDUM BENZOICTJM (BENZOIC ACID). 

What is benzoin? 

Benzoin is the concrete juice, occurring in tears, obtained from incisions 
into Styrax Benzoin, a Peruvian tree. It is a balsam, being composed 
chiefly of resin and benzoic acid, with the occasional presence of cinna- 
mic acid. It also contains a volatile oil. It owes its efficiency chiefly to 
benzoic acid. 

What are the preparations of benzoin ? 

Ammonii Benzoas, ] 
Lithii Benzoas, i -, 

Sodii Benzoas, \ dose ^ ™ x - 

Acidum Benzoicum, J 

Tinctura Benzoini, 20 per cent. , dose t^xx-xl. 

Tinctura Benzoini Composita ("friar's balsam") contains benzoin, 
storax, balsam of Tolu, and aloes ; dose 3ss-ij. 

What are the source and appearances of benzoic acid ? 

Benzoic acid is obtained by sublimation from benzoin, or it may be 
made artificially from hippuric acid, the latter, however, lacking the 
characteristic vanilla-like odor and being used only in the arts. It takes 
the form of shining hexagonal scales with a slightly aromatic odor, warm 
acid taste, and acid reaction. It is soluble in 500 parts of water, and 
freely so in ether, alcohol, and in 7 parts of chloroform. 

What effects does it produce ? 

Locally, it is an irritant and protoplasmic poison, and is about equal 
to salicylic acid as a germicide. In therapeutic doses it is followed by 
very few symptoms, and its chemistry in the body is not clearly under- 
stood. In large doses it increases the circulatory and respiratory force, 
and is claimed to produce a greater fall of temperature than salicylic acid. 
It stimulates the cutaneous and bronchial secretions. Its chief effect of 
interest is in acidifying the urine, which is accomplished by its conver- 
sion into hippuric acid, which takes place in the kidneys, and probably 
at the expense of the uric acid, which is therefore decreased. It pro- 
duces none of the unpleasant effects of salicylic acid. 

What are the uses of benzoic acid ? 

This drug is a standard remedy in cystitis and whenever there is a 
tendency to the formation of phosphatic calculi. It has also been advo- 



ANTIPYRINUM. 125 

cated in acute rheumatism, in which it is less efficacious and better borne 
than salicylic acid ; in diphtheria, locally and internally ; and in diabetes. 
Its antiseptic properties will be noticed elsewhere. 

What are the properties, effects, and uses of sodium benzoate ? 

The benzoate of sodium is a white, amorphous, freely-soluble powder, 
having a faint odor of benzoin, a sweetish astringent taste, and a neutral 
reaction. It has been used in the same conditions as benzoic acid — viz. 
rheumatism, cystitis, and diphtheria, in the last of which it is given in 
large doses. 

Has benzoate of lithium any advantages ? 

This salt has recently been introduced for use in the uric-acid diathesis. 
The theory of its action is that the formation of uric acid is lessened by 
the benzoic acid, and that the lithium element will form with the re- 
mainder the more soluble lithium urate, and hence is the more readily 
eliminated. It is better borne by the stomach than benzoic acid. It is 
also antiseptic. 

ANTIPYRINUM (ANTIPYRIN), 

What are its sources and properties? 

Antipyrin is derived by a complicated patented process from chinoline, 
a coal-tar derivative. Chemically, it is oxydimethylchinicin, and occurs 
as a somewhat bitter grayish crystalline solid, easily soluble in water, 
alcohol, and chloroform. 

What are its physiological effects? 

Given in medicinal doses (gr. xv. ) in fevered patients, it produces a 
fall of temperature which reaches a maximum in from two to five hours, 
lasts five to eight hours, and is generally accompanied by sweating and 
slight depression. Owing to its slow elimination the duration of its anti- 
pyresis is greater than that of other antipyretics of this group. After 
larger doses or continued administration it causes general malaise, a pecu- 
liar cyanosis of the skin, feebleness of the pulse, and frequently an erup- 
tion which may resemble urticaria, measles, or erythema, and may be 
accompanied by oedema, catarrhal inflammations of the mucous mem- 
branes (conjunctivitis, coryza, or laryngitis), and sometimes by constitu- 
tional disturbances. In detail its effects are as follows : 

Nervous System.— Giddiness, somnolence, unconsciousness, coma, and 
epileptiform convulsions may occur after large doses from some unex- 
plained cerebral influence ; the spinal cord is at first stimulated and then 
depressed, the reflexes becoming tardy or abolished, while both motor 
and sensory nerves are depressed. 

Circulation. — In sufficient dosage it is undoubtedly a cardiac depres- 
sant; the arterial pressure is at first increased and later decreased, a 
vaso-motor dilatation taking place at the surface, to which, rather than 



126 ANTIPYRETICS. 

to the diaphoresis, the fall of temperature is due, as it takes place 
nearly to the same degree when atropine is given to check the sweating. 

Respiration. — This function is not affected by moderate doses; by 
large ones it is depressed, dyspnoea and rapid breathing occurring in 
some cases. 

Temperature. — The lowering of temperature is due, as we have seen, 
partly to diaphoresis, but principally to increased heat-radiation, and per- 
haps to a lessened heat-production, resulting from a direct influence on 
the thermogenic centres. That the latter is a probable element is shown 
by the lessened elimination of nitrogenous waste in the urine under its 
use. Antipyrin is well borne by the stomach, especially when adminis- 
tered with wine or aromatics. 

What are the uses of antipyrin ? 

Antipyrin maybe therapeutically employed for the following : (1) to 
reduce temperature and abate accompanying symptoms in typhoid, typhus, 
pneumonia, the exanthemata, etc. whenever it is evident that the eleva- 
tion of temperature of itself is harming the patient ; (2) to allay motor- 
excitability in chorea, epilepsy, dysmenorrhoea, after-pains of labor, etc. , 
but there are better remedies ; (3) to relieve pain in migraine, neuralgias, 
the lightning pains of locomotor ataxia, etc. ; in rheumatism it acts much 
like salicylic acid, reducing the temperature and relieving pain, but 
affording no security against relapses ; (4) it is considerably used as a 
substitute for morphine in attempting the cure of the morphine habit ; 
it is a valuable haemostatic : thus, spraying or sniffing it up the nose will 
often check epistaxis, and haematemesis < and haemoptysis are said to be 
benefited by its exhibition by stomach or inhalation, as the case may be. 

How is antipyrin prescribed ? 

It may be given in solution, pill, or capsule. When given in fevers 
for antipyretic purposes it is best to administer it in alcohol, to counter- 
act its depressing effects ; dose gr. v-xv. 

ANTIFEBRIN. 
What is antifebrin? 

This drug is an anilin derivative, and chemically is acetanilid or phenyl- 
acetamid. It is an odorless, slightly bitter crystalline powder, not very 
soluble in water, but freely so in alcohol, ether, and chloroform. 

How do its effects compare with those of antipyrin ? 

Antifebrin resembles antipyrin in its action as far as this is under- 
stood, but produces less sweating, is less apt to cause cyanosis, respir- 
atory disturbance, cutaneous eruptions, and collapse, although these are 
all reported to have occurred in some cases. Some experiments have 
been made tending to show that its antipyretic effect is due to a centric 
effect upon the heat-producing nervous centre. In healthy persons little 



PHENACETIN. — THALLIN. 1 27 

or no decrease of fever is produced. It agrees well with the stomach, 
occasions no nausea, and often even promotes the appetite. 

What are the therapeutic uses of antifebrin ? 

Antifebrin in gr. iv doses _ is about equal to gr. xv of antipyrin, and 
may be used as an antipyretic in the same conditions, acting with equal 
promptness and efficiency and for nearly the same length of time. It is 
not as efficient in rheumatism and motor disturbances, but may be used 
in migraine, neuralgias, etc. It is cheaper than antipyrin. Owing to 
its insolubility, it is generally given in capsule, wafer, or tablet form. 

PHENACETIN. 

What are its properties? 

Phenacetin, which has only recently been introduced, is a tasteless, 
colorless, crystalline substance, only slightly soluble in water, but more 
soluble in alcohol. 

What are the effects and uses of phenacetin ? 

It acts as an antipyretic, without producing vaso-dilatation, with a 
varying degree of diaphoresis, and probably from an effect on the nerv- 
ous centres. Like antipyrin, it is analgesic, but unlike that drug un- 
pleasant results are seldom developed, and, being less poisonous and 
probably equally efficient, it is a valuable antipyretic. (For uses of 
phenacetin compare Antipyrin.) 

THALLIN. 

What are the properties and effects of thallin ? 

Thallin occurs in two forms, the sulphate and tartrate, both yellowish- 
white crystalline powders with a bitter taste. The sulphate, common- 
ly used, is soluble in 7 parts of water. In ordinary doses (gr. v) it 
produces a fall of temperature, at times accompanied by considerable 
sweating. After larger doses a great fall of temperature, profuse per- 
spiration, and at times an erythematous eruption and cyanosis, occur. 
The urine assumes a greenish hue under its use. _ The blood-pressure is 
diminished only by large doses. In some cases violent chills are devel- 
oped during the reactionary rise of temperature, and vomiting and diar- 
rhoea have been observed. 

What uses may it fulfil? 

Although dangerous in large doses, in repeated small doses (gr. ij-iij) 
it is an efficient antipyretic with very little danger, and may be used in 
acute rheumatism and conditions of high temperature. In 1 : 1000 solu- 
tions it is an antiseptic, and 1 J to 2 J per cent, solutions may be injected 
into the urethra with gratifying results in gonorrhoea and gleet. 



128 STOMACHIC BITTERS. 

KAIRIN. 

What are its source, effects, and disadvantages? 

Kairin is a chinolin derivative, crystalline, bitter, and easily soluble. 
In gr. v-x doses it exerts an antipyretic effect, causes copious sweating, 
and is a cardiac depressant. It has no advantages over antipyrin and 
other drugs of this group, and. although no deaths are reported from its 
use. the symptoms hare been so alarming that it has fallen into disuse. 

NAPHTHALINE. 

How is it manufactured ? What are its properties ? 

Naphthaline is a benzol derivative, obtained by dry distillation of coal- 
tar, and occurring in white, shining scales, insoluble in water, but soluble 
in alcohol, ether, chloroform, and oils. 

What effects and uses has naphthaline ? 

This drug disinfects, or at least deodorizes, the faeces. It or its prod- 
ucts are eliminated by the urine, upon which it acts as an antiseptic, 
postponing decomposition. It is chiefly used in chronic diarrhoea (gr. 
v-x in capsule every four or six hours) and as a disinfectant in intes- 
tinal catarrh*. It is also highly spoken of in bronchitis and bronehor- 
rhoea and in diseases of the intestinal tract. Locally, in 10 per cent, 
oily solution it is used in scabies and prurigo. At one time it bade fair 
to be useful in typhoid fever, and some cases were supposed to be 
aborted by its use, but it has not sustained its reputation. 

STOMACHIC BITTERS. 

What are the classes of bitters ? 

The vegetable bitters may be arranged in three classes: (1) simple or 
pure bitters ; (2) aromatic bitters, which contain a volatile oil as well as 
bitter principle; (3) the astringent bitters, which contain tannic and 
gallic acids, and are astringent as well as tonic. 

What effects are common to bitter tonics? 

Probably all bitter substances increase more or less the activity of the 
glands with which they come in contact, and thus promote digestion and 
increase the appetite. The increased ingestion of food and improved 
assimilative powers affect the general nutrition, so that they are indirect 
tonic*. In over-doses they are somewhat irritant, and may cause nausea 
and occasionally vomiting and diarrhoea. 

When are they indicated ? when not ? 

Bitters are chiefly of use when the appetite is poor and during slow 
convalescence from acute disease. They are contraindicated when there 
is inflammation or over-sensitiveness of the alimentary tract. 



QUASSIA. — CALUMBA. 1 29 

SIMPLE BITTEES. 

QUASSIA. 

What are its source and active principle? 

Quassia is the wood of Plcrcena excelsa, a tree of the West Indies. 
It is odorless, but very bitter, and yields its activity, which is due to a 
neutral principle, quasstn, to both alcohol and water. 

What preparations are used ? 

Extractum Quassiae, dose gr. j-iij. 

Extractum Quassiae Fluidum, dose niv-xv. 

Tinctura Quassias, 10 percent., dose 3J— Ij. _ 

Quassin, the bitter principle, may be given in gr. ss doses. 

For what purposes are they used ? 

Like other simple bitters the preparations of quassia may be used in 
anorexia, atonic dyspepsia, chlorosis, and atonic conditions generally. 
An infusion ( §j — ij to Oj), as we shall see later, is an excellent injection 
for " seat- worms. ' ' 

GENTIANA (GENTIAN). 

What are its source and composition ? 

Gentian is the' root of Gentiana lutea, a perennial plant of the Alps. 
Water and alcohol extract its virtues, which reside in an intensely bitter 
principle called gentio-picrin, besides which gentian contains a fixed oil 
and gentisic acid, which is tasteless and inert. 

What are its preparations, effects, and uses ? 

An extract, fluid extract, and compound tincture are officinal, the last 
of which contains gentian, cardamom, and bitter orange-peel, and is 
probably more used than any other simple bitter (Tinctura Gentianae Com- 
posita, 3j-ij). Gentian is a very efficient bitter, and is said to be some- 
what laxative in large doses. The indications for its use are the same as 
for Quassia, q. v. 

CALUMBA (COLUMBO). 

What are its source and constituents ? 

Calumba, or columbo, is the root of Jateorrhiza calumba, a climbing 
plant of Mozambique. It contains two bitter principles, columbin and 
berberine, columbic acid, and starch, and yields its bitterness to alcohol 
and water. 

What are the preparations, effects, and uses of calumba ? 

Calumba, the powdered root, dose gr. x-xx. 

Extractum Calumbae Fluidum, dose ttLx-xx. 

Tinctura Calumbae, dose 3j-^ss. 

Calumba is very slightly aromatic, is very well borne by the stomach, 

9— M. M. 



130 STOMACHIC BITTERS. 

and may be used whenever a simple bitter is indicated, sharing with 
gentian the preference among bitter tonics of its class. 

CHIRATA. 

What are its chief points of interest ? 

Chirata, which is the entire herb of Ophelia chirata, an East Indian 
plant, contains a bitter principle, chiratin, and ophelic acid. It is one 
of the best of the simple bitters, resembles gentian, and may be used in 
the same ways. 

The preparations are — 

Chirata, dose gr. xx. 

Extr. Chiratse Fl., dose 3ss. 

Tinctura Chiratae, 10 per cent,, dose 3j-ij. 

HYDRASTIS. 
Give its derivation and properties. 

Hydrastis, known variously as golden seal, yellow root, orange root, 
etc., is the rhizome and rootlets of Hydrastis Canadensis, a small 
native plant. It contains a yellow alkaloid, hydrastine, a white one, 
berberine, and probably a third, xanthopaccine, besides starch, sugar, 
etc. The exact status of this drug is not clear, recent experiments 
having shown it to be allied to strychnine. At present it seems best 
to consider it in this connection. 

What are its preparations? 

Extractum Hydrastis Fluidum, most used, dose 3ss-ij 
Tinctura Hydrastis, 20 per cent., dose 3ss-j. 

What effects does it produce ? 

Hydrastis is a stomachic bitter, with a particular stimulant effect on 
the hepatic and intestinal secretions. Given to frogs, the alkaloid, hy- 
drastine, heightens the reflexes and excites motor irritability, producing 
tetanic convulsions ; but these effects are much less in degree and longer 
of duration than those of strychnine. The circulatory effects are dis- 
puted : probably the heart is slowed and the arterial pressure raised as 
by digitalis, with a later depression of the vaso-motor system. It is 
said to be diuretic, and it possesses the power to produce contractions in 
the non-pregnant uterus, and is said to have produced abortion. 

What therapeutic utility has hydrastis ? 

Hydrastis is used as a tonic in dyspepsia and chronic gastritis ; also in 
duodenal catarrh, catarrhal jaundice, and constipation, from its stimu- 
lant effect on the hepatic secretion. Cystitis is said to be benefited by 
its use, while gonorrhoea in the declining stages and gleet are improved 
by urethral injections of the fluid extract (tt\,xv to oJ)> as are otorrhoea, 



SERPENTARIA. ANTHEMIS. 131 

leucorrhoea, and other mucous discharges. Menorrhagia and metrorrhagia 
are often decidedly benefited by the fluid extract in repeated doses, 
either alone or combined with ergot. 

AROMATIC BITTERS. 

As we have already seen, the essential constituents of drugs of this 
class are a volatile oil and a bitter principle. Most of them contain in 
addition more or less tannic acid. 

SERPENTARIA (VIRGINIA SNAKEROOT). 
What are its source and constituents? 

Serpentaria consists of the rhizome and rootlets of Aristolochia serpen- 
taria and A. reticulata, two indigenous plants. These contain a volatile 
oil, bitter principle, resins, and tannin, and have an agreeable aromatic 
odor and bitter somewhat pungent taste. 

What are its preparations? 
Extractum Serpentariae Fluidum, dose fflx-xxx. 
Tinctura Serpentariae, 10 per cent., dose 5j~Sss. 

What are its effects and uses ? 

Serpenteria is a stimulant tonic, with somewhat diuretic and diapho- 
retic properties. In large doses it may cause vomiting, purging, and other 
symptoms of gastro-intestinal irritation. It is an elegant tonic, and is 
often combined with stronger bitters, and also with cinchona, in the 
treatment of intermittents (see Huxham's Tincture) and in slow conva- 
lescence from fevers. 

ANTHEMIS (CHAMOMILE). 

What is chamomile, and what are its active principles ? 

This drug is the floicer-heads of Anthemis nobilis, a small trailing plant 
of Europe, cultivated also in this country. It contains a volatile oil a 
bitter principle, and a trace of tannic acid, and has a strong, peculiar 
odor, probably due to anthemic acid. 

What are its effects and uses? 

Chamomile is a good stimulant tonic, especially used during convales- 
cence. The usual method of administration is in infusion, dose §ij two 
or three times daily. In larger doses of the hot infusion it is an emetic. 
Of the powder the dose is 3ss-j. 

Matricaria, or German Chamomile, the flowers of Matricaria 
chamomilla, is very similar in composition and properties, but its taste is 
more disagreeable, and it is seldom used in this country. 



132 STOMACHIC BITTERS. 

EUPATORIUM. 

What are its botanical name and its active principles ? 

Eupatorium perfoliatum, boneset or thoroughwort, is a common indig- 
enous plant, the leaves and flowering tops of which are officinal, and con- 
tain a bitter glucoside, eupatorin, tannic acid, and a small amount of 
volatile oil. It is usually given in infusion, but has an officinal fluid ex- 
tract, the dose of which is ^Ixx to 3j. 

What are its effects and uses? 

Thorough wort is a stomachic tonic, expectorant, and diaphoretic, and 
in large doses may prove emetic. It is a standard domestic remedy for 
' ' cold ' ' and bronchitis, for which it is given in hot infusion freely, and 
has been used in rheumatism with asserted good effect. 

CASCARILLA. 

What are its source, contents, and uses ? 

Cascarilla is the bark of Croton eluteria, a small tree of the West 
Indies. It yields its properties to alcohol and partially to water, and has 
an agreeable aromatic odor, most noticeable when burning. It contains 
a crystalline, bitter principle, cascarillin, a volatile oil, a resin, and some 
tannic acid. It is a pleasant aromatic bitter, well borne by the stomach, 
and may be used for the same indications as serpentaria. The dose of the 
powder is gr. xx-xxx. No officinal preparations. 

CIMICIFUGA. 

What are its source and contents? 

Cimicifuga, or black snakeroot, is the rhizome and rootlets of Cimici- 
fuga, racemosa, an indigenous herb. Its exact status as to classification 
is not clear. It contains, however, a volatile oil, which gives to the plant 
its characteristic odor, tannic and gallic acids, a resin, and a not yet iso- 
lated active principle. 

What effects does its administration produce ? 

The taste of the drug is bitter and slightly astringent, and in small 
doses it promotes the appetite and digestion. It slows the heart, and 
raises, and after large doses lowers, the arterial pressure, thus acting like 
digitalis, but much less powerfully. On the uterus and unstriped mus- 
cle it acts like ergot, but less energetically, increasing the muscular con- 
tractility of that organ. Anodyne and soporific properties are claimed 
for it. It undoubtedly increases the secretions of the skin and bronchial 
mucous membrane. 

For what is it used? 

As a stomachic bitter cimicifuga is used in dyspepsia, especially if 
atonic or irritative ; as a cardiac tonic it may be an available succeda- 
neum to digitalis ; sedative and analgesic effects are claimed for it in acute 



CORNUS.— PRUNUS VIRGINIAKA. 133 

rheumatism and neuralgia; while by a tonic action on the unstriped 
muscular fibre it is probably of use in congestive dysmenorrhea, subinvo- 
lution of the uterus, and spermatorrhoea. It is also a good expectorant 
in bronchitis. 

Absinthium, the tops and leaves of Artemisia Absinthium, and 
Magnolia, the bark of different varieties of Magnolia, belong also to 
this class, but are seldom used. 

ASTRINGENT BITTERS. 

. Cinchona and its alkaloids have already been discussed : they are very 
valuable stomachics in small doses. 

CORNUS. 

What are its source and constituents? 

This drug is the bark of the root of Cornus florida, or dogwood, a 
small indigenous tree. The taste is bitter, astringent, and slightly aro- 
matic. Its constituents are cornin, resin, and tannic and gallic acids. 

What are its effects and uses? 

It is a bitter, and is said to have antiperiodic effects as well. In too 
large doses it may prove irritant enough to cause gastric disorder. 

Salix is the bark of Salix alba (white willow) and other varieties of 
Salix. It is chiefly of interest because of its neutral principle, salicin, 
which, as we have seen, is an antirheumatic and antiseptic. 

PRUNUS VIRGINIANA (WILD CHERRY). 

What is it, and upon what does its activity depend ? 

Wild cherry, officinally Prunus Virginiana, but more properly P. ser- 
rotina, is an indigenous tree, the bark of which contains a bitter principle, 
tannic and gallic acids, amygdalitis and emulsin. Amygdalin is a glu- 
coside which, with emulsin, a ferment, in the presence of water yields 
on distillation a volatile oil containing hydrocyanic acid. Emulsin is an 
albuminous substance, and is coagulated by heat, so that the value of 
the bark is impaired by boiling. 

What are the preparations of wild cherry ? 

Prunus Virginianse, powdered, dose 3ss-j. 
Extractum Pruni Virginianae Fluidum, dose 3ss-j. 
Infusum Pruni Virginianae, 4 per cent., dose ^j-ij. 
Syrupus Pruni Viginianae, 16 per cent., dose 3ij-\?ss. 

What are its effects and uses ? 

Wild cherry bark is a somewhat astringent stomachic tonic, and, owing 
to the hydrocyanic acid developed, a nervous and circulatory sedative. 
In the natural bark, however, this is present in a rather small percentage, 



1 34 DIURETICS. 

and most of the proprietary cough medicines are probably c ' fortified ' ' 
with it. The syrup and the fluid extract are much used as vehicles, and 
possess a certain tonic sedative effect which renders them of value in 
phthisis. 

DIURETICS. 
Define diuretics. 

Diuretics are remedies which increase the renal secretion, either by a 
direct stimulating effect on the secreting cells or by increasing the blood- 
pressure generally or locally. The ingestion of large amounts of fluid 
may also prove diuretic by flushing out the kidneys. It is to be borne 
in mind that the secretions of the skin and intestinal tract may be affected 
vicariously, and when a purely diuretic action is required these should 
be avoided ; but in practice it ordinarily matters little how the fluid is 
eliminated. 

SCILLA (SQUILL). 

What is squill, and what are its constituents ? 

Squill is the bulb of Urginea scilla, a plant of the lily family whose 
habitat is the Mediterranean shores. These bulbs resemble onions in 
their appearance, and are found in the shops sliced and dried. Two 
varieties, the red and the white, are recognized, but they are of equal 
efficiency medicinally. Squill contains as active principles scillipicrin, 
scillitoxin, and scillin, and yields its activity to water, alcohol, and 
vinegar. 

What preparations are officinal? 

Pulvis Scillae, dose gr. j-ij. 

Extractum Scillae Fluidum, dose TUj-ij. 

Tinctura Scillae, 16 per cent., dose tt\,x-xx. 

Acetum Scillae, 10 per cent., dose Trtxv-3ss. 

Syrupus Scillae (^xxv-gr. j), dose 3ss-j. 

Syrupus Scillae Compositus ("hive syrup") contains squill and senega, 
ad* 6 ; tartar emetic, y part in 100 = about gr. j to §j of tartar emetic ; 
dose 3ss-gss. 

What are the physiological effects of squill ? 

In small doses squill increases the secretions of the bronchial and intes- 
tinal mucous membranes and of the kidneys, its diuretic action being the 
most constant, and probably due both to direct stimulation of the renal 
cells and to the increased biood- pressure which it causes. Whether the 
actual elimination of urinary solids is increased is not clear. In larger 
doses it is a gastric and an intestinal irritant, causing nausea, vomiting, and 
purging. In toxic doses it produces symptoms of severe gastro-intestinal 
and renal irritation — viz. violent vomiting, purging, and abdominal pain, 
with bloody, suppressed, and albuminous urine — collapse, and death. 



SCOPAHIUS. —APOCYNUM. 135 

What are the uses of squill ? 

This drug is used as a diuretic in conditions not dependent upon ne- 
phritis, in which condition it is distinctly contraindicated. Thus it is em- 
ployed in ascites, in chronic pleurisy, or pericarditis with effusion, and in 
cardiac dropsies, in which it is combined with digitalis. Combinations 
of digitalis, squill, and calomel are much in favor in the above condition. 
Squill is also efficient as a blennorrhetic expectorant in subacute and 
chronic bronchitis, especially when the expectoration is viscid and tena- 
cious. 

What are the toxic dose and treatment ? 

Gr. xxiv. of squill have proved fatal. Sufficient has been said of the 
symptoms. The treatment consists in evacuation of the stomach if 
necessary, the free administration of opium and demulcents, with warmth 
and stimulation as necessity arises. 

SCOPARIUS (BROOM). 

What is scoparius, and to what does it owe its activity ? 

Scoparius is the tops of Sarothamnus scoparius, or common broom- 
plant, a native of Europe, but cultivated in this country. These dried 
tops have a strong, peculiar odor and a bitter, nauseous taste. Broom 
contains a neutral principle, scoparin — which by some authorities is con- 
sidered unimportant, by others to represent its diuretic and purgative 
properties — and sparteine, an alkaloid already discussed under Cardiants. 
It has no officinal preparations, an extemporaneous decoction being most 
used. 

What are its effects and uses ? 

In moderate doses scoparius is an efficient hydragogue diuretic, and in 
large doses may produce purgation and even vomiting. In general 
dropsy it proves a very valuable diuretic. Of a decoction ( gj to Oj boiled 
down to Oss) §j-ij may be given every two hours. 

APOCYNUM (CANADIAN HEMP). 

What are its active principles? 

Canadian or Indian hemp is the root of Apocynum Cannabinum,^ an 
indigenous herb. It contains apocynin, gallic and tannic acids, a bitter 
principle, etc., and yields its virtues to both water and alcohol. The taste 
of apocynum is bitter, acrid, and nauseous. The powdered root alone is 
officinal. It is generally prescribed in infusion (3ss to Oj of water or 
gin), the dose of which is 3ij-3 ss - 

What are its effects and uses ? 

Canadian hemp increases the secretions of the skin, bronchi, and kid- 
neys^ and in large doses is an intestinal irritant, causing vomiting and 
purging. In dropsy it proves a powerful remedy. 



136 DIUBETICS. 

TRITICUM. 

What are its main points of interest ? 

Triticum, or couch-grass, is the rhizome of Triticum repens, a peren- 
nial herb of Europe and North America. The rhizome has a sweetish 
taste, due to the presence of several sugars. Although only a feeble 
diuretic, it is of considerable value as a sedative to the genito-urinary 
tract, especially in cystitis with profuse mucous discharge. The best 
form of administration is in an infusion or decoction. Of the officinal 
fluid extract the dose is 3ss-§ss. 

VASCULAR DIURETICS. 
What are vascular diuretics? 

Drugs of this class produce diuresis by increasing the general arterial 
tension. Among them are such valuable diuretics as digitalis, strophan- 
tus, and caffeine, which have already been fully treated of under Car- 
diants. Certain diaphoretics, to be later described, act, when the per- 
spiration is lessened in any manner, to produce diuresis — e. g. jaborandi. 

REFRIGERANT DIURETICS. 
POTASSIUM. 

What are the physiological effects of potassium salts ? 

Foremost among diuretics of this class are the acetate and citrate of 
potassium. As the effects of potassium salts are in a considerable 
measure due to the potassium element or modified by it, a good oppor- 
tunity is here afforded for the study of these effects. Locally, some of 
the potassium salts, as potassa fusa, dissolve albumin and saponify fats, 
thus acting as caustics. Internally, they depress the spinal cordfand 
lessen reflex excitability. They are all cardiac depressants, in moderate 
doses slowing the heart, while larger ones also lower arterial tension. 
Animals poisoned die by cardiac paralysis, the paralyzant effect being 
direct upon the heart-muscle. However, in ordinary medicinal doses, 
small doses, the effect is not so clear, and in man there is very little 
danger. Given in large or continued doses, they promote oxidation of 
the tissues, markedly increase the urinary solids, and if too long con- 
tinued cause emaciation and perverted nutrition ; the blood contains less 
fibrin, and the venous blood is lighter in color. After large doses of the 
nitrate or chlorate the haemoglobin is decomposed, niethaemoglobin is 
formed, and the oxidizing power of the blood is diminished. 

Secretions. — The acetate and* citrate of potassium, which are neutral 
at first, are partially oxidized in the blood, and are converted into car- 
bonates — viz. become alkaline after absorption — and are said to be alka- 
ligenous. These alkaligenous salts, and those whose solutions are already 
alkaline (potassium hydrate, carbonate, tartrate, and the tartrate of 
sodium and potassium), increase the alkalinity of the blood, render the 



POTASSIUM CABBOtfATE. — POTASSlI ACETAS. 13? 

urine alkaline, and act as alkalies upon the glands with which they come 
in contact, increasing the activity of those whose secretions are acid, de- 
creasing that of glands with alkaline secretions. The nitrate, chlorate, 
sulphate, and bitartrate have no such effect, being permanently acid or 
neutral. 

In large doses potassa, or the chlorate, nitrate, or carbonate, causes 
vomiting, purging, and other symptoms of gastro-intestinal irritation, 
accompanied by more or less marked nervous symptoms and collapse. 
Elimination of potassium salts takes place largely by the urine. Some 
of the preparations of potassium require detailed notice. 

POTASSIUM CARBONATE. 

Describe it. 

The carbonate of potash is prepared by purification ofpearlash, which 
is an impure carbonate obtained from wood-ashes and other sources, or 
by calcining the bicarbonate of potash, thus depriving it of one molecule 
of C0 2 and reducing it to the carbonate. It is a coarse white, granular 
powder of alkaline reaction, freely soluble in water, and deliquescing in 
moist air to an oily liquid. It is chiefly employed as an antacid and 
diuretic. In large doses it is a corrosive poison, the antidotes for which 
are oils and dilute acids. 

POTASSIUM BICARBONATE. 

What is it ? 

This salt is made by passing C0 2 through an aqueous solution of puri- 
fied pearlash until saturation is reached. It occurs as prismatic crystals. 
permanent in the air and easily soluble in water. The effects of this salt 
resemble those of the carbonate, except that it is better borne by the 
stomach, and it may be used as an antacid. It is a favorite in acute 
rheumatism and gout, in which conditions it is freely used up to Siss 
daily, with opium, if necessary, to relieve pain. 

POTASSII ACETAS. 

What are its properties, actions, and uses? 

Acetate of potash is a white, extremely deliquescent salt, neutral in 
reaction, and very soluble in water. It is formed by evaporating a solu- 
tion of the bicarbonate in acetic acid. As noted above, it is alkaligenous, 
alkalizing the blood and urine, promoting diuresis, and increasing the 
solids of the urine, with the exception of the uric acid, which is dimin- 
ished by the increased oxidation. It constitutes one of the best forms 
of administration for the alkaline treatment of acute rheumatism, while 
in subacute forms combinations with the iodide of potash are valuable. 
In the acute form it should be given freely, gj— iss daily. It is also of 
service in catarrhal jaundice and functional disorder of the liver, as a 
prophylactic against uric- acid calculus, and by alkalizing the urine it 



138 DIURETICS. 

affords relief in acute cystitis and urethritis. It can be administered in 
lemon-juice. 

POTASSII BITARTRAS. 

What are its source, properties, effects, and uses? 

This salt, also known as cream of tartar or acid potassium tartrate, is 
obtained by purifying argot, which is deposited during fermentation on 
the sides of wine-casks. It has an acidulous taste, is insoluble in alcohol, 
and only slightly soluble in water, in which, however, it may be easily 
dissolved by adding borate of sodium. It is the most active diuretic of 
the potash salts, and in large doses a hydragogue cathartic. It is chiefly 
used in general dropsies of cardiac or renal origin, in which its double 
action as diuretic and cathartic renders it particularly valuable. 

POTASSII NITRAS. 

What is the history of its formation ? 

This salt, nitre or saltpetre, is obtained from natural or artificial nitre- 
beds, in which it has been formed by the oxidation of ammonia and its 
subsequent combination with the bases of the soil. It is a crystalline 
substance of saline and rather cooling taste, soluble in 5 parts of water 
and insoluble in alcohol, and decomposing when heated, with the libera- 
tion of nascent oxygen. 

What are the effects of nitre ? 

Applied to any raw surface or mucous membrane, salpetre acts as a 
decided irritant, and it is due to this property that poisonous effects more 
often follow its ingestion than that of other salts. The symptoms of 
poisoning are severe epigastric burning pain, violent vomiting, at times 
of blood, purging, followed very shortly by collapse and great muscular 
weakness. Nervous symptoms may or may not be pronounced as in 
other gastro-intestinal irritation. Suppression of urine may occur. The 
lesions at autopsy are intense gastro- enteric inflammation, often to the 
extent of ulceration of the mucous membrane. Although probably no 
more depressing to the heart than other potassium salts, aside from the 
depression secondary to this inflammatory condition, it does seem to pro- 
duce more renal irritation. The treatment consists in giving opium and 
demulcents after evacuation of the stomach and bowels. It is now 
seldom used, and is chiefly of interest from its toxic effects. It was 
formerly thought to do good in rheumatism. 

POTASSII CHLORAS. 

What is its preparation ? What are its effects ? 

This salt is prepared by various processes. It occurs as a white, an- 
hydrous, fairly permanent salt, of a cool saline taste, and soluble in 16 
parts of water. Absorbed, and to a very great extent at least elim- 



BUCHU. — PAREIRA. 139 

inated in its own form, it does not differ decidedly in its effects from 
other potassium salts except in its irritant effects, which are similar to 
those of the nitrate. In poisonous doses it produces symptoms resem- 
bling those detailed under that drug. In continued doses it is apt to 
produce chronic parenchymatous nephritis. It does not give up its nas- 
cent oxygen at the body- temperature, as was once supposed, and experi- 
ments have shown that it is nearly all eliminated in its own form. 
Hence the theory of its oxidizing power is no longer held. 

What are its uses? 

Chlorate of potash has been extensively used in diphtheria, scarlet 
fever, and other conditions supposed to depend on a poisoned condition 
of the blood, and is still considered valuable by some. Locally, as a 
gargle or mouth-wash, it is of value in simple and mercurial stomatitis, 
ozcena, subacute and chronic pharyngitis, and foetid ulcerations of the 
mucous membranes generally. 

BLENNORRHEAS. 

What are the effects and varieties of blennorrhetics ? 

Blennorrheas are remedies which promote secretions of mucous mem- 
branes, and are used to restore a healthy action in cases of deficient, ab- 
normal, or excessive secretion. They are principally employed in such 
conditions of the bronchial mucous membrane (expectorants) and of the 
genito-urinary tract (blennorrhetic diuretics). 

BUCHU. 

What is buchu, and what are its active principles ? 

Buchu is the leaves of Barosma betulina ; habitat, Southern Africa. 
These leaves have a bitter taste _ and aromatic odor, contain a bitter ex- 
tractive and a volatile oil, and yield their virtues to water and alcohol. 

What are its effects and uses ? 

Buchu is slightly diuretic and a gentle stimulant to secretions gen- 
erally, with a selective action on the urinary mucous membrane. It is 
used in chronic pyelitis, chronic ostitis, chronic urethritis, and may be 
made to act as a diaphoretic in cutaneous troubles. From its bitter 
principle it may prove tonic. The fluid extract is officinal (dose 3j) 5 but 
an infusion is the more ordinary way of administering it. 

PAREIRA. 

What is pareira ? What are its effects and uses ? 

Pareira or Pareira brava is the root of Chondodendron tomentosum, a 
climbing plant of Brazil. It contains an alkaloid (cissampeline?), a 
resin, starch, etc. It imparts its activity to water, and the fluid extract 



140 BLENNOBRHETICS. 

(dose 3j) and extemporaneous infusions are the proper preparations for 
use. It is a mild tonic, laxative, and diuretic, and an efficient corrective 
to chronic inflammation or irritation of the bladder. 

MATICO. 

The leaves of Artanthe elongata, a Peruvian shrub. It contains 
resin, tannin, volatile oil, and a bitter principle, maticin. Matico is an 
aromatic tonic and a stimulant alterative to diseased mucous membranes, 
especially those of the bladder and bronchi. It has a reputation as a 
haemostatic also. Dose of the powdered leaves, 3ss-iij ; of extractum 
matico fluidum, 3ss-ij ; and of the 10 per cent, tincture, 3j-ij. 

UVA URSI (BEARBERRY). 

What is uva ursi ? and what does it contain ? 

Arctostaphylos uva ursi is a shrub of this and other countries, the 
leaves of which are officinal. They contain tannic and gallic acids, a 
bitter principle, and arbutin or ursin, which is a glucoside and the active 
principle of the drug. 

What are the effects and uses of arbutin ? 

Arbutin is a mild diuretic, with an alterative effect upon the mucous 
membrane of the genito-urinary tract. It is partially decomposed in 
the kidneys, with the production of glucose and hydrochinon, and partly 
eliminated unchanged. It asepticizes the urine and postpones decom- 
position. From its combined astringent, diuretic, and alterative effects 
it is of value in chronic pyelitis and chronic cystitis, and is especially effi- 
cacious as a palliative when the latter is due to enlarged prostate. It is 
said in some cases to prevent bleeding from the kidneys. The fluid ex- 
tract (extractum uvae ursi fl. ) is officinal in 3ss-j doses. 

JUNIPERUS (JUNIPER). 

What is juniper and its oil ? What are their effects and uses ? 

Juniperus is the fruit or so-called berries of Juniperus communis, a 
shrub of Europe naturalized in this country. These berries are of the 
size of a pea, and have a sweetish, aromatic taste resembling turpen- 
tine. They yield their activity, which depends upon a volatile oil (oleum 
juniperi), to boiling water and alcohol. Like other drugs of this class, 
the oil is diuretic, and, like oil of turpentine, is somewhat irritant to the 
gastro-intestinal tract, producing strangury and bloody urine when given 
in large doses. It may prove emmenagogue. The oil, which is officinal, 
is chiefly used as a vehicle for potassii bitartras and other saline diuretics, 
and for its own action in chronic pyelitis, cystitis, etc. The preparations 
are as follows : 

Oleum Juniperi, dose ttlv-xv. 



CHIMAPHILA. TEREBINTHINA. 141 

Spiritus Juniperi, 3 per cent, of the oil, dose 3ss-j. 
Spiritus Juniperi Compositus (corresponds closely to Holland gin), 
dose 3.ij-^ss. 

CHIMAPHILA. 

What are chimaphila and its constituents ? 

Chimaphila umbellata is a small, indigenous, perennial plant, the 
haves of which are officinal and # contain tannin, arbutin, and other 
principles. Arbutin is its most active principle, and its effects and uses 
are therefore the same as those of uva ursi — viz. tonic, slightly astrin- 
gent, and diuretic. Of the fluid extract the dose is Z] or more. 

OLEUM ERIGERONTIS. 
What is this oil, and what are. its effects and uses ? 

This oil, known also as oil of fleabane, is a volatile oil distilled from 
Eiigeron Canadense, or Canada fleabane, and having properties much 
like oleum terebinthinse. It is, however, weaker and more pleasant to 
the taste. It possesses haemostatic and diuretic properties, and has been 
used in chronic catarrhs of the genito-urinary organs, in dysentery, and 
in uterine hemorrhage ; dose gtt. v-xxx, frequently. 

TEREBINTHINA (TURPENTINE) ; OLEUM TEREBIN- 
THINiE (OIL OF TURPENTINE). 

Define a turpentine, and mention some of the varieties. 

A turpentine is a liquid or semi-solid vegetable juice which contains 
resin and oil of turpentine. There are two officinal and several non- 
officinal turpentines: (1) Common American white turpentine, obtained 
chiefly from Pinus Australia, or yellow pine, growing chiefly in the 
Southern States; (2) Canada turpentine, also called Canada balsam, the 
product of Abies balsamea, or American silver fir, growing in the 
northern portions of North America. Among the non-officinal varieties 
are Bordeaux, Venice, and Chian turpentines. 

What are the peculiarities of turpentines ? 

They are inflammable, insoluble in water, and quite soluble in alcohol 
and ether. By distillation, as stated above, they yield resin and oil of 
turpentine, both of which are officinal. 

Oleum Terebinthinse (Spirit of Turpentine). — This, the active 
principle of turpentine, is a colorless, volatile, inflammable liquid of a 
strong penetrating odor and hot pungent taste. It is insoluble in water, 
moderately soluble in alcohol, and freely so in ether. When exposed to 
the air it absorbs oxygen and converts it into ozone. 

What physiological effects does turpentine produce? 

Locally turpentine is a powerful irritant. Internally in medicinal doses 



1 42 BLENNORRHETICS. 

it produces gastric warmth, exhilaration, and a sort of intoxication : the 
pulse is increased in force and frequency. It is eliminated by the bronchi 
and kidneys, imparting its odor to the breath and an odor of violets to 
the urine. Poisoning by turpentine is rare, because in large doses the 
drug is eliminated by the bowel before absorption can take place. The 
symptoms produced by too large doses are abdominal burning, vomiting 
and diarrhoea, strangury, priapism, constant desire to urinate, suppres- 
sion of urine or haematuria, complete unconsciousness, and a weak and 
rapid pulse. The lethal dose must be very large, and has not been 
determined. Its effects in detail are as follows: 

Circidation and respiration stimulated by small and depressed by large 
doses. 

Genito-urinary System. — After small doses few symptoms are pro- 
duced except some increase in the amount of urine, with perhaps lum- 
bar pain, frequent micturition, and burning pain in the urethra during 
the act : the effects of larger doses have been given above. Turpentine 
is eliminated by the bronchi and genito-urinary mucous membrane. 

What are its uses therapeutically? 

Locally, spirit of turpentine is much used as a counter-irritant over 
large surfaces in the form of turpentine stupes, which are best made by 
wringing out cloths in hot water and then in turpentine or sprinkling 
them with turpentine. Turpentine stupes are valuable in bronchitis, 
abdominal pain, and applied over the bladder will often relieve reten- 
tion of urine, especially when of nervous origin. Turpentine in amounts 
of 3j-.§ss is a valuable addition to enemata in cases where the rectum is 
impacted with faeces. Internally, it is used in typhoid fever : in two 
stages of this disease it is very valuable. In the second and third weeks 
the distressing tympanites may be markedly decreased by gtt. x. of the 
oil every three or four hours, its action being a local stimulation of the 
muscular coat of the intestinal wall, while in convalescence, which is pro- 
tracted and accompanied by diarrhoea, in which case ulceration may be 
suspected, this drug is a valuable stimulant, promoting healing. In other 
ulcers of the stomach and bowels it acts locally in the same way. In 
chronic pyelitis and chronic cystitis it does good. In impotence, sperma- 
torrhoea, and gleet due to relaxed conditions of the parts these condi- 
tions are not infrequently greatly benefited by moderate and continued 
doses. In passive hemorrhages from mucous surfaces, as hematuria, 
purpura, scorbutus, etc. , it is quite generally useful. In adynamic con- 
ditions it is also useful as a general stimulant. Its use as a tseniacide will 
be mentioned later. In flatidence, chronic intestinal catarrh, and sub- 
acute dysentery it does good by stimulating peristalsis and by its sup- 
posed antifermentative action. Owing to its elimination by the 
bronchial mucous membrane it is used as a blennorrhetic expectorant 
in chronic bronchitis and emphysema, and may palliate in gangrene of 
the lung. 



COPAIBA. — CUBEBA. 143 

COPAIBA. 

What is copaiba, and what are its physical and chemical prop- 
erties ? 

Copaiba, or copaiva, is an oleoresin derived from the Copaifera Langs- 
dor fii, a South American tree. It is a yellowish liquid of a peculiar 
terebinthinate odor and nauseous, burning taste. It is insoluble in water, 
but soluble in alcohol, ether, and the fixed and volatile oils. It is resol- 
vable into a volatile oil and a resin, both of which are officinal. To call 
it a balsam is incorrect, as it contains no benzoic or cinnamic acid. 

What are the preparations of copaiba ? 

Of copaiba itself the dose is wixx-xl. 

Oleum Copaibae, dose fflx-xv. 

Resina Copaibse, dose gr. x-xv. 

Massa Copaibge (copaiba 94, magnesia to 100 parts), dose gr. x-xx. 

What effects does it produce ? 

In medicinal doses copaiba produces no systemic effects. In large 
doses in susceptible persons it may cause fever, hot skin, gastro-enterie 
irritation, and not infrequently an exanthematous eruption very like 
measles. Its chief effects, however, are local. It is diuretic, the resin 
being even more so than the oil, and an alterative to the genito-urinary, 
and perhaps the bronchial, mucous membrane. Large doses in suscep- 
tible persons may produce strangury and renal irritation, even to the 
extent of hematuria. Under its use it is to be remembered that the 
urine gives with nitric acid a white precipitate resembling albumin, but 
differing from it in being soluble in alcohol. It is slowly eliminated, its 
constituents appearing in the urine for as much as four days after large 
doses. 

What are its therapeutic indications ? 

Copaiba is chiefly used in subacute and chronic inflammations of the 
genito-urinary tract. In gonorrhoea it finds its great popularity, and is 
indicated in the subacute stages. During the acute it is too stimulating, 
although used by some. It is also used, as are the other drugs of this 
class, in chronic pyelitis and cystitis, and by some in chronic bronchitis 
and chronic diarrhoea. Ointments containing it often afford considerable 
relief in hemorrhoids. 

How is it best administered ? 

Copaiba or its oil may be given in capsule or in an emulsion of some 
aromatic substance, the latter of which is said to agree better with 
delicate stomachs. 

CUBEBA (CUBEB). 

What can you say of cubeb and its properties ? 

Cubeb is the unripe berries of Cubeba officinalis, a climbing plant of 
Java and the East Indies. These berries have a characteristic aromatic 



144 CATHARTICS. 

odor and a peculiar camphoraceous taste. Their important constituents 
are a volatile oil (oleum cubebae) and two sorts of resin, the one hard 
and insoluble in ether, the other soluble in that menstruum and known 
as cubebic acid. 

What preparations of cubeb are officinal? 

Pulvis Cubebae, dose 3ss-ij. 
Oleum Cubebae, dose tt^x-xxx. 
Extractum Cubebae Fluidum, dose i^x-xl. 
Oleoresina Cubebae, dose tt\,x-xv. 
Tinctura Cubebae, 10 per cent,, 3ij-iv. 
Trochisci Cubebae, No. j. 

What are its physiological effects? 

Cubeb exerts a stomachic effect much like pepper, which after large 
doses becomes an active irritant. Medicinal doses do not produce 
much systemic effect, but large ones may be slightly stimulant to the 
circulatory function. Its characteristic effect, however, is stimulation of 
the mucous membranes, with a selective action on that of the genito- 
urinary tract. It is a diuretic, this property, it is said, residing in the 
resin, while a carminative effect is claimed for the oil. An eruption like 
that of copaiba may follow its use. 

For what is cubeb used ? How is it administered ? 

Its uses correspond very nearly with those of copaiba, with which it is 
often beneficially combined. It is less apt to derange digestion. Cubeb 
may be given in powder or syrup. The oleoresin nearly represents the 
drug and may be given in emulsion. 

OLEUM SANTALI. 

What are its points of interest ? 

Oil of santal- or sandal-woodis a yellowish, strongly volatile oil of a 
very characteristic odor, and obtained by distilling the wood of Santalum 
album, an East Indian tree. It is readily soluble in alcohol. It is 
used as a substitute for copaiba in gonorrhoea, succeeding best in the 
subacute stages, and is also of value in chronic bronchitis and chronic 
inflammations of the genito-urinary tract. 



CATHARTICS. 

What are cathartics, and how do they act ? 

Cathartics are drugs which act to produce or increase the evacuations 
from the bowels. They may act either by stimulating the glandular 
secretions of the mucous membrane or of the highly specialized glandular 
organs, the liver and pancreas, or by stimulating the muscular coat of 



LAXATIVES. — MAGNESIA. 1 45 

the intestine, and thus increasing the peristalsis. Different drugs have 
selective actions on different parts of the intestine. 

How are cathartics classified? 

Cathartics are classified, according to the vigor and method of their 
action, into laxatives, salines, astringent resin-bearing purgatives, hy- 
dragogues, and mercurials. 

LAXATIVES. 
What are laxatives ? 

Laxatives are cathartics which mildly produce* evacuations, chiefly by 
an effect on the muscular coat and slightly on secretions. The following 
are thus classed : 

Tamarindus, the preserved pulp of Tamarindus Indica, a large 
East Indian and African tree, dose §ss-^j or more. It is an ingredient 
of confectio sennge. 

Manna, which is the concrete saccharine exudation in flakes of 
Fraxinus ornus, a Sicilian tree, contains a resin as its probable active 
principle, and mannite, a sugar. It is chiefly used for children because 
of its agreeable taste. 

Sulphur, washed sulphur (sulphur lotum), is a mild laxative. It 
slightly increases the secretions, producing stools which are soft and 
very offensive from sulphuretted hydrogen gas (H 2 S). It is valuable in 
painful anal diseases, as fissures, hemorrhoids, etc. , to relieve the pain of 
defsecation. (See Pulv. Glycerrhiz. Comp.) 

Oleum Ricini (castor oil) is an oil expressed from Eicinus communis, 
a tree of the East Indies, but cultivated as an annual plant in other 
latitudes. It is also obtained by decoction and by solution in alcohol, 
but the expressed oil is the best. It is a familiar amber-colored liquid 
of nauseating taste. It contains palmitic and ricinoleic acids (the latter 
peculiar to itself) and an unknown drastic element. 

Castor oil acts in from four to six hours. It stimidates peristalsis, 
excites very slightly the glandular secretions, and is not a cholagogue. It 
has an astringent after-effect. It is used when a thorough evacuation, 
as of scybalous masses, is desired, and also in diarrhoeas due to the inges- 
tion of some irritating substance, and in dysentery. For these latter pur- 
poses it is combined with or followed by opium or some astringent. It 
is especially useful in infantile diarrhozas. 

Magnesia, Magnesia Ponderosa, Magnesii Carbonas. — 
These preparations are all white powders, nearly insoluble in water, and 
may be classed with salines, than which, however, their action is much 
milder. They are mild laxatives and antacids. Magnesia is said not 
to be laxative except when combined with acids forming soluble salts, so 
that when this effect is desired it should be followed by an acid, as 
citric acid or lemonade. 

Magnesia Ponderosa (or heavy magnesia), the dose of which is 
the same as magnesia, 3ss-3ij, has the same effects. 
10— M. M. 



146 CATHARTICS. 

Magnesium Carbonate is more sedative to tbe stomach from evo- 
lution of C0 2 gas. Although laxative, the chief use of these magnesia 
preparations is as antacids. 

Pulvis Glycerrhizse Composita contains senna 18, sulphur lotum 
8 parts, with licorice, fennel, and sugar to 100 parts. The senna and 
sulphur are its active principles, while fennel acts as a mild antispas- 
modic. It is a deservedly popular laxative, but may cause griping. 

Cassia Fistula is the pulp of the long pods of Cassia Fistula, an 
Egyptian tree ; it is chiefly used as an ingredient of confectio sennae. 

Oleum Olivse, Oleum Amygdalae Bxpressum, and Oleum 
Lini are laxatives, but are chiefly used in laxative enemata. The last 
may be used by mouth. 

SALINES. 
How do they act? 

They increase both secretions and peristalsis, producing loose, watery 
stools, with very slight irritation and without systemic depression. They 
act fairly quickly, especially if taken on rising. Their purgative action 
is due slightly to increased peristalsis, but chiefly to increased secretion 
and to a free outward osmosis of the body fluids, which is not a true 
secretion of the glandular apparatus. 

What are the most important salines? 

Magnesii Sulphas (sulphate of magnesia or sal Epsom) is a white, 
slowly-efflorescent salt, very soluble in water, and having a nauseating 
bitter taste, although fairly well borne by the stomach ; dose 3ij to §j. 

Liquor Magnesii Citratis, the dose of which is §vj-xij, and 
Magnesii Citras Granulatus, in doses of 5j to gss, are also much 
used. The former is effervescent from the reaction of citric acid and 
bicarbonate of potash, and is a pleasant and mild cathartic. The latter 
is a coarsely granular powder, deliquescent on exposure to the air, and 
soluble, with free effervescence, in water. It should be kept in closely- 
corked bottles. 

Potassii et Sodii Tartras (sal Rochelle) occurs as slightly efflores- 
cent crystals, of mildly saline and bitter taste, and freely soluble in water ; 
dose | ss ~j- 1^ i s frequently prescribed in the pulv. effervescens comp., 
or Seidlitz powder, which consists of sal Rochelle £ij and sodii bicarb, 
gr. xl in the blue, and tartaric acid gr. xxxv in the lohite paper, to be dis- 
solved in water and taken while effervescing. 

In what conditions are salines useful? 

In ascites, renal, and cardiac dropsies salines are very valuable by pro- 
ducing watery transudation from the intestines and lessening the work of 
the kidneys. They are especially efficacious in ascites if pressure be not 
too great ; in uraemia, oedema of the brain, and cerebral hyperemia, as 
depletants. In dysentery sal Epsom and sal Rochelle are much used. 
They lessen the hyperaemia of the mucous membrane and cause faecal 



SALINES. — ASTRINGENT PURGATIVES. — RHEUM. 147 

evacuations, with a decrease of pain and distressing tenesmus. After ab- 
dominal operations, when the temperature is rising, they assist in the 
removal of deleterious matter, and do good by depletion, and are now 
commonly employed by most laparotomists. In so-called faecal anaemia, 
or anaemia with constipation, they are advantageously combined with 
iron. 

What special uses has magnesium sulphate ? 

In lead constipation, lead colic, and saturnine cachexia the sulphate of 
magnesium is very valuable to prevent the reabsorption of the lead from 
the bile, in which it is largely excreted. It accomplishes this by forming 
the insoluble lead sulphate. PbS0 4 . 

In carbolic poisoning this and other soluble sulphates form insoluble 
sulphocarbolates and prevent absorption. 

Name other members of this group. 

Other unimportant members of this group and their doses are— 
Sodii Sulphas, sulphate of soda or Glauber's salt, an ingredient in 

many mineral waters, §ss or less. 

Sodii Phosphas (phosphate of soda), dose 3yj-3iss. 

Potassii Sulphas (sulphate of potassium), dose 3ss-ij.^ 

Potassii Bitartras (or cream of tartan, a good diuretic, but weak 

laxative; dose Sss-j. 
Few of these salines are now used as laxatives. 

ASTRINGENT RESIN-BEAKING PURGATIVES 

These drugs act strongly in both ways — viz. increasing both secretions 
and peristalsis — but do not produce inflammatory changes. The group 
includes several important purgatives. 

RHEUM (RHUBARB). 

What is it ? and what is known of its composition ? 

Rhubarb is the root of Rheum officinale and other varieties of Rheum. 
Its composition is not yet fully determined. It contains a resinous body, 
chrysophanic, rheumic, and rheotannic acids, to the last of which is due 
its astringent after-effect. 

What are its preparations? 

Rheum, powdered, dose gr. v-xx. 

Pilule Rhei. each = gr. iij. 

Extractum Rhei. dose gr. v-x. 

Extractum Rhei Fluidum, dose ^Iv-xxx. 

Pilulae Rhei Compositae. containing in each rheum gr. ij, purified aloes 
gr. jss. myrrh gr. j. and ol. menth. piper, gr. xo\ Xo. j-iij. 

Palvis Rhei Compositus (Gregory's powder), dose oss-j. 

Tinctura Rhei, dose 3j-ij. 



148 CATHARTICS. 

Tinctura Rhei Aromatica (rhubarb 20 per cent. , with cinnamon, cloves, 
and nutmeg), dose 3ss-j. 

Tinctura Rhei Dulcis (rhubarb 8 per cent., with licorice, anise, and 
cardamom), dose 3ij-iv. 

Syrupus Rhei, dose §ss-j. 

Mistura Rhei et Sodae (contains of ext. rhei fl. , sodii bicarb, and spts. 
menth. pip. 3 per cent, each), dose gss— ij. 

Vinum Rhei, dose 3j-^ s s. 

What are its physiological effects? 

In small doses rhubarb is a tonic astringent and stomachic ; in sufficient 
amount (gr. iv-vj) a slow and mild cathartic, only occasionally causing 
griping. It increases the secretions of the intestinal mucous membrane, 
and is a cholagogue, the last-named action being probably due to its 
resin, phceoretin. 

In what conditions is rhubarb of value ? 

In intestinal dyspepsia due to deficiency of the intestinal and hepatic 
secretions small doses do good ; in jaundice from catarrh of the duodenum 
or bile-ducts, especially when occurring in children ; in summer diarrhoea 
it has a secondary astringent effect, and nothing is more often used than 
the aromatic syrup or one of the tinctures. 

SENNA. 
Give its source and composition. 

Senna consists of the leaflets of Cassia acutifolia and Q. elongata, 
shrubs of Egypt and Arabia. Its activity resides in a glucoside. cathartic 
acid : it also contains chrysophanic acid and other substances not well 
understood. ' 

Give its preparations. 

Confectio Sennse contains senna 10 per cent., with tamarind, cassia 
fistula, prunes, etc. ; dose 3j-ij. 

Extractum Sennae Fluidum, dose 3j-iv. 

Infusum Sennae Compositum ("black draught") contains senna 6 
per cent., manna and mag. sulph. da. 12 per cent.; dose giv. 

Syrupus Sennae, dose 3j-iv. 

Pulvis Glycerrhizae Composita (for which see Laxatives), dose 3ss-ij. 

What are the effects and uses of senna ? 

Senna is a prompt and efficient cathartic, acting in about four hours 
to produce copious liquid stools, without any irritation. It is probably 
slightly cholagogue, and increases the secretion of the whole intestinal 
canal. It has a slight tendency to produce griping. Its uses are those 
of the class to which it belongs. 



ALOE. — CASCAEA SAGE ADA. 149 

ALOE (ALOES). 
What is aloes ? 

Aloes is the inspissated juice of Aloe Socotrina and other varieties of 
aloe which are not officinally recognized. Three sorts are known to com- 
merce : Cape, Socotrina, and Barbadoes aloes. It contains, as its active 
principle, a neutral substance, ahin (dose gr. i-ij), which may vary 
slightly in different varieties of aloes ; also a resin, which is not purga- 
tive when pure. 

What are its preparations? 

AloePurificata, } dose gr. ij-xv. 

Extractum Aloes Aquosum, dose gr. j-v. 

Pilulse Aloes, each = gr. ij. 

Pilulse Aloes et Asafoetidse : one pill contains gr. 1 J of each. 

Pilulse Aloes et Ferri, aloes and dried sulphate of iron, of each gr. j, 
with aromatic powder ; used in amenorrhoea. 

Pilulse Aloes et Mastiches (Lady Webster's dinner pill), aloes gr. ij, 
mastic and red rose da. gr. \ in each pill. 

Pilulse Aloes et Myrrhse, aloes gr. ij, myrrh gr. j, and aromatic powder 
gr. i in each pill. 

Tinctura Aloes, 10 per cent., dose 3ss-ij, ] 

Tinctura Aloes et Myrrhae, dose 3j-ij, > seldom used. 

Vinum Aloes, dose 3J— iij, j 

What are the effects and uses of aloes ? 

Aloes is a very slow cathartic (ten to twelve hours), acting mostly on 
the peristalsis of the large intestine, but in large doses increasing the 
secretions of the liver and mucous membranes. It is said to cause con- 
gestion of the pelvic viscera. It is a favorite in intestinal dyspepsia with 
torpidity of the liver and of the muscular coat of the intestinal wall. 

OASOARA SAGRADA. 

What is cascara sagrada ? 

Cascara sagrada (non-officinal in 1880) is the bark of Khamnus pur- 
shiana, or California buckthorn. 

How does it act? 

Cascara is a particularly good stimulant of peristaltic action, especially 
that of the lower bowel. It also exerts a tonic effect on unstriped mus- 
cle. Hence it has become a standard remedy in chronic constipation. 
Of the fluid extract ttl,x-3ss may be given two or three times daily, 
beginning with the smaller dose and giving just enough to produce a 
free morning evacuation. It hag a tendency to produce griping, and 
may be advantageously combined with belladonna or hyoscyamus to pre- 
vent this. 



150 CATHARTICS. 

FRANGULA. 

What can you say about frangula ? 

Frangula is the bark of Rhamnus frangula, or alder buckthorn. When 
green it has an emetic tendency. When dry it is cathartic and diuretic, 
and also an anthelmintic of value ; dose of fluid extract 3ss-j. 

Juglans is the inner bark of J. cinerea (butternut) ; extract officinal. 

Leptandra is the rhizome and rootlets of L. Virginica, or Culver's 
physic ; the extract and fluid extract are officinal. 

DRASTIC PURGATIVES (HYDRAGOGUES). 

How are these defined? 

Drastics, or hydragogues, act very powerfully both upon the secretions 
and peristalsis, the more powerful and active of them producing in large 
doses severe gastro-enteritis and poisoning. 

JALAPA (JALAP). 

What are its source and composition ? 

Jalap is the tuberous root of Exogonium purga, a Mexican plant. Its 
activity resides in a resin which is officinal, and consists of two portions, 
both cathartic, the one soluble in ether, the other insoluble. The latter 
is known as convolvulin, and is probably the more active. 

What preparations are used? 

Jalapa, powdered, dose gr. xv-3ss. 
Abstractum Jalapae, dose gr. v-xv. 

Pulvis Jalapae Compositus (about one-third jalap, two-thirds potassium 
bi tartrate), used as cathartic and diuretic ; dose 3ss-j. 
Resina Jalapas^see above), dose gr. ij-v. 
Pilulae Catharticae Compositae. (See Colocynth.) 

What effects are produced? 

Jalap is a powerful hydragogue cathartic, acting very promptly. _ It 
is an hepatic stimulant, markedly, increases the secretions of the intestinal 
glands, producing large watery stools, and may cause griping. It is much 
used in ascites, general dropsy, and threatened uraemia, the compound 
jalap powder being a favorite prescription. 

PODOPHYLLUM (MANDRAKE). 
What is its source and composition? 

Podophyllum is the rhizome and rootlets of Podophyllum peltatum. 
The officinal resin is an alcoholic extract of the root, and contains, be- 
sides berberine, two resinous cathartic principles — one neutral, the other 
acid in reaction. 



CHELIDONIUM. — SCAMMONIUM. 151 

What are its preparations? 

Pulvis Podophylli, dose gr. xv-xx. 
Abstractum Podophylli, dose gr.v-x. 
Extractum Podophylli, dose gr. i-ij. 
Extractum Podophylli Fluidum, dose ^Iv-xv. 
Resina Podophylli (note the dose), dose gr. J-j. 

What are its effects and uses? 

Mandrake is a powerful hydragogue cathartic, but slow in its action ; 
also an hepatic stimulant, and has a tendency to act upon the upper in- 
testinal tract Hence it is useful in intestinal indigestion and consti- 
pation dependent on deficient hepatic secretion and torpidity of the intes- 
tinal wall, in portal congestion, jaundice, and ascites. 

CHELIDONIUM. 
What is chelidonium ? 

Chelidonium is the herb of Chelidonium majus. It has no officinal 
preparations and no therapeutic importance. It is a hydragogue cathar- 
tic, and is said to be narcotic. 

IRIS. 

What are the source, active principle, and preparations of iris ? 

Iris is the rhizome and rootlets of Iris versicolor, or blue flag. It con- 
tains a resin, to which is probably due its activity. Iris stimulates the 
hepatic secretion and that of the intestinal glands, and in large doses 
causes violent vomiting and purging, with depression. It is used in (1) 
jaundice, especially of malarial origin ; (2) functional disturbance of the 
liver (torpidity so called) ; (3) intestinal dyspepsia ; and (4) dropsy. The 
following preparations are officinal : 

Pulvis Iridis, dose gr. v-xv. 

Extractum Iridis, dose gr. i-ij. 
"Extractum Iridis Fluidum, dose tn^iij— x. 

EUONYMUS. 
What are its source, composition, etc.? 

Euonymus, or wahoo, is the bark of Euonymus atropurpureus, a native 
shrub. It contains euonymin, a resin, etc. It produces a powerful stim- 
ulation of the hepatic secretion, and to a less extent of the intestinal, 
and may be, but seldom is, used for this purpose. An extract is officinal, 
the dose of which is gr. i-ij. 

SCAMMONIUM. 
How is it used ? 

Scammony is a resinous exudation from the root of Convolvulus scam- 
monia, a Syrian vine. A resin called scammonin constitutes 80 to 90 



152 CATHARTICS. 

per cent, of its weight, and is colorless, tasteless, and soluble in alcohol 
and ether. It is a powerful hydragogue cathartic, and seldom used 
alone. Of the drug the dose is gr. v-x ; of its resin, which is officinal 
as resina scammoniae, gr. iij-vj. It is most used in the compound ex- 
tract of colocynth, of which, this resin constitutes 14 per cent. 

COLOCYNTHIS. 

What are its source and composition? 

Colocynthis (genitive colocynthidis) is the fruit of Citrullus colocyn- 
this, or bitter cucumber. It yields its active principle to water and alco- 
hol, and contains a resin, colocynthin, a glucoside (?), and colocynthitin. 

What preparations are important ? 

Extractum Colocynthidis, dose gr. ij-v. 

Extractum Colocynthidis Compositum (contains of the extract 18, 
aloes 50, resin of scammony 14 parts, with cardamom and soap to 100 
parts), dose gr. j-xv. 

Pilulae Catharticae Compositae, a pill in very common use ; contains 
of the above compound extract gr. 1 J, abstract of jalap and calomel da. 
gr. j, and gamboge gr. \. 

What are the effects and uses of colocynth ? 

Even in very moderate doses this drug is a gastro-intestinal irritant, a 
powerful cholagogue, and a hydragogue. Owing to its liability to cause 
inflammation, it is used only in combinations, chiefly as the compound 
extract, which is a safe and efficient purgative. 

CAMBOGIA. 

What are its source and only officinal preparation? 

Camboge (or more properly gamboge) is a gum-resin procured from 
Garcinia Hanburii, a tree of Siam. It is composed of about 80 per 
cent, of resin, is officinal only in the compound cathartic pill, of which 
it constitutes 10 per cent., and is^ a gastro-intestinal irritant and hydra- 
gogue cathartic, but not an hepatic stimulant. 

ELATERINTJM. 
What is it ? 

Elaterin is the active principle of elaterium, a substance deposited 
from the juice of the fruit of Ecballium elaterium, or squirting cucumber. 

What are its properties, effects, and uses ? 

Elaterin occurs in colorless, odorless, bitter crystals, insoluble in water 
and readily soluble in alcohol. It is a very violent hydragogue, power- 
fully irritant, and may cause death. It is also slightly diuretic. It is 
used in uraemia and as a revulsive in cerebral affections, also in general 
dropsy and ascites, but is unsafe. Dose of elaterin gr. ^VrV 5 of tritu- 



OLEUM TIGLII. 153 

ratio elaterini, which was the only officinal trituration in the U. S. P. of 
1880, the dose is gr. i-j. 

OLEUM TIGLII (CROTON OIL). 
What is croton oil ? 

This drug is a fixed oil from the seeds ^ of Croton Tiglium, an East 
Indian shrub. The oil of the shops is a mixture of t\ie fixed oil proper, 
a resin, and tiglinic acid. The purgative principle has not been isolated. 
A principle called crotonol is said to produce the irritant effects upon the 
skin. It is a viscid, reddish-brown liquid, with a slight peculiar odor 
and bitter acrid taste. It is soluble in ether and slightly so in alcohol. 

What are its effects in medicinal and large doses locally ? 

In doses of gtt. j-iij it is a very powerful hydragogue cathartic, act- 
ing slightly also as a diuretic. Larger doses, unless vomited, may cause 
fatal gastro-enteritis. It is unreliable, however, and at times large doses 
may not affect the bowels. It is the quickest of cathartics, often taking 
effect in from one-half to two hours. Locally applied, it causes a vesic- 
ular and pustular eruption somewhat resembling that of small-pox. 

What are its uses? 

It is extremely valuable as a revulsive cathartic in cerebral and 
ursemic conditions when swallowing is difficult or impossible (gtt. ij-iij 
dropped on the tongue or taken in bread-crumb), and may be useful in 
very obstinate constipation and in severe dropsies if the general con- 
dition be good. 

MERCURIAL CATHARTICS. 
What preparations of mercury are here considered ? 
Hydrargyri Chloridum Mite (calomel), dose gr. t^-xx. 
Massa Hydrargyri (blue mass), dose gr. xft-xx. 

What peculiar features do mercurial cathartics possess? 

The purgative action of these mercurials is characteristically sloiv, ten 
to twelve hours elapsing before catharsis is produced. They are also 
uncertain in their action, and are often used in combination with or 
followed by other cathartics, generally salines. They act by increasing 
the flow of bile into the intestine, and by increasing the secretions of the 
mucous membrane and pancreas. _ Whether an actual increase in bile- 
production occurs is doubtful, their probable effect being to cause the 
gall-bladder to empty itself by reflex irritation. Thus they are called 
by Bruce indirect cholag agues. Frequently repeated small doses (gr. ^ 
to i) are given when exhibited with the view of acting on the liver. 
Blue mass resembles calomel in its action, but is weaker and more uncer- 
tain, and is seldom now used as a cathartic. 



1 54 ANTHELMINTICS. 

What are the uses of calomel ? 

Calomel is used as a purgative when there is a deficiency of bile in the 
intestine. In small repeated doses (gr. AHj) ^ Wl ^ often check obstinate 
vomiting. It was formerly, and is still occasionally, used as an antiphlo- 
gistic. It has mild diuretic and anthelmintic properties. 

ANTHELMINTICS. 

What are anthelmintics ? Vermifuges ? Vermicides ? 

Anthelmintics are remedies which promote the expulsion of worms 
from the intestinal tract ; vermifuges expel parasites ; vermicides kill as 
well as expel them. They act in one of three ways : (1) mechanically ; 

(2) by some intoxicating influence ; (3) by an actual poisonous .effect. 

What are the parasites against which they are directed ? 

The parasites which we are ordinarily called upon to treat are — (1) 
Ascaris or Oxyuris vermicularis, the so-called "seat-worm," which in- 
habits the large intestine, especially the rectum, and in females the 
vagina; (2) Ascaris lumbricoides, or "round-worm," which exists in all 
parts of the alimentary tract; and (3), most important of all, Taeniae, 
of which three varieties are known — Taenia solium, Tamia mediocanel- 
lata, and Tamia bothriocephalic latus. The first two are by far the most 
common in this country. 

What is the treatment for oxyuris? 

For the expulsion of this parasite enemata of the following are avail- 
able and efficacious^ (1) infusions of quassia; (2) decoction of aloes; 

(3) weak solutions of carbolic acid ; (4) plain water or salt and water fre- 
quently repeated. As a safeguard against auto-infection by mouth from 
the fingers strict cleanliness of the hands must be enforced. For the 
Ascaris lumbricoides the following remedies are employed : 

SANTONICA. 

What are its source and composition? 

Santonica is the unexpanded,/?owers of Artemisia maritima, or Levant 
wormseed ; habitat, Persia and Asia'Minor. Among other elements it 
contains a neutral principle, crystalline, colorless, odorless, and practically 
insoluble in water, called santonin, which represents the virtues of the 
drug. 

Preparations and doses of santonica ? 

Pulvis Santonicae, dose gr. x-£ss. 

Santoninum, dose gr. ij-iv ; for child two years old, gr. ±-i. 
Sodii Santoninas. 

Trochisci Sodii Santoninatis ; each equals gr. j ; 

The santoninate of soda is freely soluble, and is not safe to employ as 
a vermifuge. 



SPIGELIA. — ASPIDIUM. 155 

What are its effects ? and what is its principal use ? 

In ordinary medicinal doses santonin produces no obvious effects. 
Large doses may cause g astro-enteric irritation and chromatopsia. Ob- 
jects in the visual field are generally colored yellow, but occasionally 
green, blue, or even red. The urine is colored yellow. Toxic doses 
cause severe cerebral symptoms, but such toxic effects are rare. The 
only use of santonica and its principle, santonin, is in the expulsion of 
the round-worm. For this purpose it should be given on an empty 
stomach and followed by a brisk cathartic. 

SPIGELIA. 

What are its source and preparations? 

Spigelia, or pmkroot,is the rhizome and rootlets of Spigelia mari- 
landica, the Carolina pink. The dose of the powdered root is 3j-ij. 
An extract is officinal in doses of 3j-ij. 

What are its effects and uses? 

The effects of this drug correspond closely to those of santonin, except 
that no visual symptoms are produced. By some it is considered the 
best remedy for the round-worm. The method of administration is the 
same as for santonin. 

Chenopodium. — Chenopodium, or American wormseed, is the fruit 
of Chenopodium anthelminticiim, an indigenous plant. It is a very 
efficient remedy for this purpose. Oleum chenopodium is the only 
preparation used ; dose gtt. v-xv ; for a child of two years, gtt. iv-viij. 

Azedarach. — This drug is the baric of the root of Melia azedarach, 
or bead tree, of Syria, Persia, and India. It is said to somewhat re- 
semble spigelia. It possesses no officinal preparations, but repeated 
doses (^ss-j) of a decoction over a period of some days are claimed to 
be effectual. 

What preliminary measures are necessary to expel taeniae? 

In the treatment of taeniae the preliminary measures are as important 
as the drugs themselves. The patient should fast for from twenty-four 
to forty-eight hours, and a thorough purgative should be taken. Then 
the drug selected should be administered, followed in a few hours by 
another brisk cathartic. No case is to be considered cured until the 
head is discovered by a microscopic examination. 

The following drugs are used to expel tseniae : 

ASPIDIUM. 

Give its source, composition, and preparation. 

Aspidium, or male fern, is the rhizome of Aspidium Jilix mas or 
Aspidium marginale, the former a plant of Europe, the latter indige- 
nous. Its activity is supposed to depend on filicic acid, which can be 
extracted with ether. The other constituents are unimportant. Used 



156 ANTHELMINTICS. 

with the preliminaries mentioned above, it is an efficient remedy against 
all taeniae. Dose of the oleoresin, 3ss-ij. 

GRANATUM. 

What are its important features? 

Granatum is the bark of the root of Punica granatum, or pome- 
granate. Its active principle is pelletierine, or pelleterine, which is also 
used, and is of equal efficiency. Pomegranate causes some intestinal 
disturbance, and generally purges, failing in which it should be followed 
by a brisk cathartic. It is a very certain taeniafuge, and is generally 
administered in the form of a decoction of the fresh root. Of pelletier- 
ine the dose is gr. iij-v ; in larger doses its effects are said to somewhat 
resemble curare. 

KAMALA. 
What is kamala ? 

Kamala, or rottlera, consists of the glands and hairs from the capsules 
of Mallotus Philippinensis, a small tree of Asia, Australia, and else- 
where. It imparts its virtues to alcohol, and, having no officinal prepa- 
rations, may be used as a tincture. It is fairly efficient. The dose of 
the powder is from 1 to 2 drachms. 

BRAYERA. 
What is brayera ? 

Bray era, or kousso (cusso), is the female inflorescence of Brayera an- 
thelmintica. Its efficiency as a taeniafuge is doubtful, and its popularity 
is waning. Dose of the powder 3ss ; of the fluid extract 3 s s-jss ; of 
a 6 per cent, infusion gviij. 

PEPO (PUMPKIN). 

What are its value and administration? 

Pepo, or pumpkin-seed, is derived from Cucurbito pepo. It is one 
of the most efficient anthelmintics. It is given in §ij-iv doses of the 
seeds pounded in a mortar with some excipient or made into an in- 
fusion. With proper preliminary precautions failure seldom attends 
its use. 

Mention some other remedies used for this purpose. 

Oleum Terebinthinse, in doses of Jj-ij, maybe used and is effect- 
ive, but has the disadvantage of sometimes causing symptoms of gen- 
ito-urinary irritation. 

Cocoanut. — The milk and meat of two cocoanuts, taken raw after 
the usual preparations (see above), have recently proved efficient, perhaps 
from their mechanical effects. 

Ailanthus, a non-officinal drug, the oleoresin or a decoction of the 
fresh bark of which may be employed. 



LOCAL EMETICS. 157 

EMETICS. 

What are emetics ? and for what purposes are they used ? 

Emetics are medicines employed to produce vomiting (emesis). They 
may be either local or general. 

Local or reflex emetics are drugs which by locally irritating the gastric 
filaments of the vagus institute an impression which is transmitted to 
the vomiting centre in the medulla, and thus establish reflex vomiting. 
Systemic or general emetics act directly upon the vomiting centre in the 
medulla after absorption inio the blood. 

What circumstances modify their activity? 

Their activity is increased when fever or gastritis obtains — decreased, 
often decidedly, in cerebral disease or narcotic poisoning. 

What are the indications and contraindications for emetics? 

Emetics are used to empty the stomach of deleterious substances, as 
poisons, etc. ; to forcibly expel substances from the pharynx and 
oesophagus ; to relax spasm, as in laryngismus stridulus and in certain 
hysterical conditions ; as nauseants to increase secretions. They are 
contraindicated in pregnancy, hernia, and cerebral endarteritis. 

LOCAL EMETICS. 

These comprise certain metallic salts, chiefly sulphates, and certain 
vegetable drugs. 

What are the principal metallic local emetics ? 

Cupri Sulphas (copper sulphate, blue stone, or blue vitriol), gr. v, 
repeated if necessary in fifteen minutes, is a prompt emetic, and produces 
only slight depression ; it is especially valuable t in narcotic and phos- 
phorous poisonings, in the latter of which it is antidotal as well as emetic. 

Zinci Sulphas (zinc sulphate, or white vitriol) corresponds to the 
above sulphate in doses of gr. x-xx, and is considered by some safer and 
more prompt ; it is not antidotal to phosphorus. 

Alumen (alum, sulphate of aluminium and potassium), Z] in syrup, 
acts as a safe but slow emetic (one-half to three-quarters of an hour). 

Hydrargyri Subsulphas Flavus (turpeth mineral), dose gr. ij-v ; 
it is tasteless, and produces emesis with very little nausea and only mod- 
erate depression ; used in croup, and quite slow in its action. 

Name the principal vegetable local emetics. 

Sinapis Alba or Sinapis Nigra (white and black mustard), 3j-ij 
in water, causes emesis without prostration. Indeed, it is a cardiac and 
respiratory stimulant. Its chief advantage, however, lies in the fact 
that it so generally available. 

Syrupus Scillse Oompositus, containing tartar emetic (gr. j to §j), 



158 EMETICS. 

senega, and squill, is much used as a nauseant and emetic in doses of 
w\,x-3ss ; known also as hive syrup. 

What other measures may at times be valuable ? 

Mechanical irritation of the pharynx with a feather or a finger, unless 
its sensibility be too much obtunded, will produce vomiting. Tepid 
water in large draughts may often prove valuable when other means are 
not at hand. 

SYSTEMIC EMETICS. 

IPECACUANHA (IPECAC). 

What are its source and active principles ? 

Ipecac is the root of Cephaelis Ipecacuanha, a small shrubby plant of 
Brazil. It contains an alkaloid, emetine, as its active principle, in com- 
bination with ipecacuanhic acid. 

What preparations are officinal? 

Pulvis Ipecacuanhae, dose gr. }-Sss. 
Extractum Ipecacuanhae Fluidum, dose TtlJ-3ss. 
Pulvis Ipecacuanhas et Opii (Dover's powder). See Opium. 
Trochisci Ipecacuanhae ; seldom used ; each = gr. \. 
Trochisci Ipecacuanhae et Morphinae ; each = gr. y 1 ^, with morph. 
sulph. gr. ±V 
Tinctura Ipecacuanhae et Opii. See Opium. 
Syrup Ipecacuanhae, 5 per cent, of fluid extract ; dose wix-^ss. 
Vinuni Ipecacuanhae, 7 per cent, of fluid extract ; dose fflx-£iij. 

What are the physiological effects of ipecac ? 

This drug may well be considered in its entirety in this connection, 
although it has other uses and actions than as an emetic. Locally, it is 
an irritant to the skin and mucous membranes. In small doses it is a 
stomachic tonic. Larger doses increase the secretions of the salivary 
glands, bronchi, stomach, skin, and liver, the bile being unaltered in its 
composition. The circulation is but little affected, but the respiration is 
slightly depressed and the surface temperature is lowered. It acts as a 
mixed emetic, both influencing the medulla and irritating the terminal 
filaments of the vagus. For this purpose the dose varies (gr. iv to xx), 
and it is preferably given in small repeated doses until emesis is produced. 
It is very mild and certain in its emetic action. 

What important uses does it fulfil therapeutically ? 

Ipecac is used as an emetic, stomachic, tonic, antiemetic, and blennor- 
rhetic expectorant. As an emetic it is used in gastric irritation caused by 
indigested food ; in sick headaches and acute indigestion, which may often 
be cut short ; in membranous croup, laryngismus stridulus, lodgment of 
foreign bodies, etc. for its mechanical effect. 

As a stomachic tonic it is a favorite in doses of gr. ^-£ in combina- 



APOMORPHINA. — SANGUINARIA. 1 59 

tion with other drugs. In the same dosage it is also valuable to check 
vomiting, the cases in which it succeeds being of nervous origin, as the 
vomiting of pregnancy, sea-sickness, sick headache, etc. As an expec- 
torant in hay fever and in the acute stages of coryza and bronchitis it 
does good by increasing the secretions. Empirically, ipecac has been 
found valuable in acute dysentery : large doses (gr. x-xx), combined with 
opium until tolerance be established that it may be retained, ameliorate 
the tenesmus and abdominal pain and give the patient great relief, and 
have seemed to decrease the mortality of epidemics. It is also employed 
in chronic dysentery and diarrhoeal diseases. If no good effect be pro- 
duced after a trial of two or three days, it is best abandoned. Carried 
to the point of producing nausea, it seems to have antihemorrhagic 
powers, and is especially recommended in uterine hemorrhage and hcem- 
optysis. 

What is its administration as regards antagonists and synergists ? 
The tannate of emetine is extremely insoluble ; hence tannic acid and 
drugs containing it should not be combined with it. Lead and mercury 
salts and vegetable acids are also incompatible. It is assisted in its 
action by all emetics and nauseants. 

APOMORPHINA (APOMORPHINE). 

What is apomorphine ? 

xipomorphine is morphine from which one^ molecule of water has been 
taken by heating morphine and hydrochloric acid under pressure. It 
occurs as a white powder, readily absorbing moisture from the air and 
becoming green in the process. Apomorphince hydrochloras is officinal, 
and is easily soluble in water. 

What are its effects and uses? 

This salt is our best example of a purely systemic emetic, acting 
equally well by stomach or hypodermic exhibition, and acting promptly 
(generally in from five to twenty minutes), with frequent repetition of 
the vomiting, which occurs wkh but little nausea. It depresses the cir- 
culation and respiration, and in fatal doses causes death by respiratory 
paralysis. After large doses convulsions followed hy paralysis may ensue. 
All these effects are entirely centric. Its only use is as an emetic (gr. I 
by mouth, gr. -^ by hypodermic injection), and it may be used when 
sudden emetic action is desired or when swallowing is difficult or impos- 
sible, but does not succeed well in profound narcosis. 

SANGUINARIA. 

What are its source and composition? 

Sanguinaria, or blood-root, is the rhizome of Sanguinaria Canadensis, 
and may be classed as an emetic. It yields its virtues, which reside in 



1 60 DIAPHORETICS. 

an alkaloid, sanguinarine, to both alcohol and water, and deteriorates by 
keeping. 

What are its preparations? 

Acetum Sanguin arise 5> 10 per cent., dose tt\,x-xxx. 
Extractum Sanguinarise Fluidum, dose rr\jij-v. 
Tinctura Sanguinarise, 16 per cent., dose rr\,x-xx. 

What are the physiological effects of sanguinaria? 

Locally, it is a decided irritant, causing violent sneezing when inhaled, 
and acro-narcotic poisoning when taken by the stomach in large doses : 
it exerts an escharotic action upon fungous granulations. Large doses 
cause collapse, with coldness of the surface, cold sweating, dilated pupils, 
and diminished reflexes ; they depress the circulation and respiration and 
cause death by respiratory paralysis. It acts as a mixed emetic, both 
local and systemic, with great nausea and depression, and is now seldom 
used for that purpose. The secretions of the stomach and intestines are 
increased, and the bile is rendered more fluid and increased in amount. 

For what is it used? 

In atonic dyspepsia, duodenal catarrh, and catarrh of the bile-ducts it 
is serviceable in small doses as a stomachic tonic ; m acute bronchitis, 
later stages, in combination as an expectorant ; in chronic rhinitis with 
hypertrophy as an insufflation ; in functional ammenorrhcea as emmena- 
gogue ; and chronic syphilitic and tubercular affections as an alterative. 

Antimonii et Potassii Tartras (tartar emetic), dose gr. j-ij, the 
latter of which has proved fatal ; it is too depressing to use except in an 
emergency, and probably acts as a mixed emetic. 

DIAPHORETICS. 

What are the uses of diaphoretics ? 

Diaphoretics are remedies employed to increase the secretory activity 
of the skin. They are employed therapeutically (1) as revulsive agents 
in the formative stages of certain diseases, acting by eliminating certain 
deleterious waste products and by relieving internal congestion ; (2) to 
hasten absorption in general dropsy and serous accumulations, as pleurisy, 
pericarditis, ascites, etc. ; (3) to eliminate poisonous materials from the 
blood, notably urea in uraemia ; and (4) to aid in the subsidence of cer- 
tain diseases which naturally end with a sweat. 

Name some non-medicinal remedies employed as diaphoretics. 

Certain measures for producing sweating are in vogue, as the hot-air 
or Turkish bath, the hot-vapor or Russian bath, and hot-water baths, 
either general or of portions of the body, as the foot-bath. Exercise, 
warm temperatures, and the ingestion of large amounts of hot fluids will 
also favor sweating. 



PILOCARPUS. 161 

How are medicinal diaphoretics classified? 

Diaphoretics are generally classified as (1) Stimulating, direct or sim- 
ple diaphoretics which enter the circulation and produce a direct stimu- 
lating effect upon the secreting tissues or their peripheral nerves : this 
class includes the diffusible stimulants and aromatic substances generally, 
and certain narcotics, notably opium and camphor; (2) Nauseating dia- 
phoretics, which act by relaxing the orifices of the glands and allowing of 
a freer transudation of fluids through them — e. g. ipecac and tartar emetic; 
(3) Refrigerant diaphoretics, which produce sweating by reducing the 
force of the circulation and restoring the secretion of the skin, which like 
that of other organs is checked in the early stages of febrile conditions. 

STIMULATING DIAPHORETICS. 
PILOCARPUS (JABORANDI). 

What are the source, properties, and constituents of pilocarpus ? 

Pilocarpus consists of the leaflets of Pilocarpus pennatifolius, a Brazil- 
ian shrub. These have a characteristic odor and a strong aromatic taste, 
and owe their activity to pilocarpine, an alkaloid of bitter astringent taste 
and soluble in all the ordinary menstrua. Another alkaloid, jaborine, has 
been isolated : it is a derivative of pilocarpine and antagonistic to it, in 
many respects resembling atropine. 

What preparations are used ? 

Pilocarpus, powdered, dose gr. xx-3j. 
Extractum Pilocarpi Fluidum, dose w\,xv-3j. 
Pilocarpine Hydrochloras, dose gr. J to i. 

What are its physiological effects? 

Secretions. — The diaphoretic action of pilocarpus or its alkaloid, pilo- 
carpine, upon which its activity depends, is due to a direct stimulation 
of the secretory nerves at their periphery. After the hypodermic admin- 
istration of the drug sweating begins quickly, reaches its maximum in one- 
half to three-quarters of an hour, and lasts from two to four hours. The 
total amount is often very large, and there is found to be a large increase in 
the amount of urinary solids, especially u rea, in its composition. The saliva 
is also often greatly increased, this increase being in inverse ratio to that of 
the perspiration. The explanation of this sialagogue effect is not clear, 
but it is due to stimulation either of the gland-cells or the nerve-endings. 
The secretions of the stomach and bronchi are also increased, in some 
cases that of the mammae ; and if the dose be too small to produce sweat- 
ing, diuresis may occur. Children require proportionately very large 
doses to produce sweating. Other effects of jaborandi are slowing of the 
pulse with increased arterial tension, reduction of temperature when 
sweating begins, and great contraction of the pupil with increased intra- 
11— M. M. 



162 DIAPHORETICS. 

ocular tension, the myosis being due to peripheral influence. It increases 
the power of uterine contractions when labor has begun. 

For what is pilocarpus used? 

This drug is serviceable in pleurisy with effusion, a very efficient means 
of promoting absorption ; in general oedema, efficient, but depressing ; 
in uraemia and puerperal convulsions this and hot-air baths are our main 
reliance ; in pulmonary oedema, cases of which have been successfully 
treated by this drug ; in muscular rheumatism, often greatly beneficial. 
In alopecia continued small doses may promote growth of hair. In 
diphtheria pilocarpus was at one time used with the idea of throwing 
off the membrane by the exudation produced. It is, however, too 
depressing. 

How is it best administered ? 

The hypodermic administration of the hydrochlorate of pilocarpine, in 
doses of gr. \ to \ in watery solution, is preferable. 

LIQUOR AMMONII ACBTATIS. 

How is it made? What are its constituent effects and uses? 

Solution of ammonium acetate or spirit of Mindererus (spiritus Min- 
dereri) is made by adding to dilute acetic acid enough ammonium carbon- 
ate to neutralize. When freshly made it contains about 7 \ per cent, of 
acetate of ammonium and free carbonic acid. It has been much, and for 
a long time, used as a refrigerant diaphoretic and diuretic, often in com- 
binations with camphor, opium, or sweet spirit of nitre, but its action in 
these directions is feeble. It has slightly stimulating properties, and 
may be used in adynamic fevers, and in frequent large doses it is often 
of value in relieving the effects of acute alcoholism. Dose §ss-j every 
two hours in sweetened water, as it is disagreeable to the taste. 

SPIRITUS ^JTHERIS NITROSI. 

This preparation, commonly known as sweet spirit of nitre, and already 
noticed under Ether, is a 5 per cent, solution of ethyl nitrite in alcohol. 
It is a pale-yellow, volatile, inflammable liquid of pleasant, ethereal odor 
and sharp burning taste. 

What are its effects and uses? 

In therapeutic doses it produces no effect beyond mild diaphoresis and 
diuresis, with a slightly stimulant effect on the nervous system. In con- 
vulsive diseases in children it seems to be antispasmodic. Inhaled in 
large doses, it produces a train of symptoms similar to those of the 
Nitrites, q. v., and may even cause death. It is much used, chiefly in 
the febrile affections of childhood, as a refrigerant diaphoretic and diuretic, 
and is especially useful when nervous symptoms and a tendency to con- 
vulsions are present, Dose n\,x-3j. 



NAUSEANT AND REFEIGERANT DIAPHORETICS. 163 

NAUSEANT DIAPHORETICS. 

As above mentioned, practically only two drugs of this class are used 
for this purpose, ipecac and antimony. 

Antimony, as tartar emetic in doses of gr.^ r V to f , may be used in 
the early or sthenic stages of acute inflammations. 

Ipecac. — The various preparations of this drug, and pre-eminently 
Pulvis Doveri, Dover's powder, have for a long time been used in this 
way and with excellent results in the early stages of ' ' cold, ' ' which may 
often be ' ' broken up " by the timely use of this drug combined with a 
hot foot-bath and a large, hot, alcoholic draught ; also in muscular and 
acute rheumatism, in which it allays the pain and produces sweating, 
thereby presumably assisting in the elimination of deleterious matters ; 
for this purpose gr. v should be given every three or four hours. In 
suppression of menstruation with very severe pain it is often particularly 
efficient. 

REFRIGERANT DIAPHORETICS. 

Name some of the more important ones. 

All cardiac depressants, as aconite, veratrum viride, and the vegetable 
acids, belong to this class. The citrate of potash is constantly employed 
in this way, either in the effervescing citrate or the neutral mixture 
(mistura potassii citratis), and is preferable to the more powerful de- 
pressants. 

Alcohol. — Alcohol in full dosage, especially when taken in hot 
drinks, causes dilatation of the cutaneous vessels and a more or less 
profuse perspiration. It is a domestic remedy of value, and is much 
used, combined with Dover's powder or a hot foot-bath, in " cold" rheu- 
matism, and dysmenorrhea. 

EXPECTORANTS. 

What are they? and how are they classified? 

Expectorants are remedies used in inflamed conditions of the mucous 
membranes to modify the secretion in some way. ( There are two classes 
of expectorants, which are to be employed judiciously according to the 
stage of inflammation. In the so-called u dry" or early stages of 
bronchial inflammations, the sedative expectorants, by nauseating and by 
lowering the arterial tension, give rise to a relaxation of the tissues 
which allows of secretion, just as is the case with diaphoretics. In the 
later subacute or chronic conditions an entirely different class, the 
stimulating expectorants, are indicated. In pneumonia expectorants are 
contraindicated, and in all inflammations of the broncho-pulmonary 
mucous membrane narcotics, as opium, hyoscyamus, and other depressing 
drugs, some of which no doubt decidedly modify secretions, are to be 
used with caution, especially in children and the aged. 



164 EXPECTORANTS. 

NAUSEATING OR SEDATIVE EXPECTORANTS. 

Two of the three sedative expectorants in common use, ipecac and 
antimony, are also diaphoretic. Lobelia is also somewhat used for this 
purpose. All of them have been already treated at length, and a few 
words only are necessary as to their expectorant properties. 

LOBELIA. 

What are its uses as an expectorant? 

Lobelia is used only when there is a tendency to bronchial and laryngeal 
spasm, as in asthma, either iodiopathic or secondary to some other con- 
dition, in whooping cough, and in laryngismus stridulus. It is a some- 
what dangerous remedy, and is now seldom used, especially in children. 

ANTIMONY. 

What are its uses and contraindications ? 

Generally used in the form of tartar emetic. It also is too depressing 
for ordinary use, but is sometimes 'of great value in cutting short an 
attack of acute bronchitis, for which purpose it has to be carried to the 
point of producing decided nausea or even vomiting. Its employment 
in children is contraindicated except in the most minute dosage. The 
wine of antimony may also be employed. 

IPECAC. 

What can you say of its value as an expectorant? 

This drug is the depressing expectorant most commonly in use. Syrup 
of ipecac is a standard remedy in the early stages of acute bronchitis, 
given in frequently repeated, moderate doses (fflxx-xxx), although 
any other preparation may be used. It is perfectly safe, and is the. best 
one of these drugs to be used in children. 

GRINDELIA. 

What is grindelia ? Upon what does its activity depend ? 

Grindelia consists of the leaves, stems, and flowers of Grindelia robusta, 
a plant of the Western States. It contains a volatile oil, resin, and an 
asserted alkaloid. The fluid extract is officinal in doses of 3ss-j. 

What are its effects? 

The taste of grindelia is pungent and persistent, and it gives in the 
stomach a sensation of warmth, at first stimulating the appetite and 
digestion, but if continued deranging them. It depresses the heart and 
lowers arterial tension (?), but after therapeutic doses these effects are 
very slight. Impairment of sensation and mobility and diminution of 
reflexes are produced by large doses. Toxic effects are rare. It is 



SENEGA. — AMMONII CHLORIDUM. 165 

eliminated by the kidneys and pulmonary mucous membrane, and par- 
takes of the character of a mixed sedative and stimulant expectorant. 

For what is it used? 

Grindelia is used principally in respiratory conditions where bronchial 
spasm is a prominent feature, as in asthma, in which its utility is very 
great 5> and in whooping cough. It may also be used in subacute and 
chronic bronchitis, and is said to be a successful stimulant of the urinary 
tract in chronic pyelitis, chronic cystitis, etc. 

Pulsatilla. — This drug, which has already been mentioned in another 
connection, is also a valuable sedative in the very early stages of acute 
bronchial inflammation. It should never be used when gastro-intestinal 
irritation is present. 

STIMULATING EXPECTORANTS. 

Some drugs which are employed as expectorants of this group have 
been already mentioned among the blennorrhetic diuretics, notably oil 
of turpentine. 

SENEGA. 

What of senega and its active principles ? 

Senega is the root of Poly gala Senega, or senega snake-root, a small 
plant of this country^ The cortical portion of the root alone is active, 
the woody part being inert. The dried root has a faint, peculiar odor, 
and a taste at first sweet and mucilaginous, but later acrid and irritating. 
It yields its virtues to both water and alcohol, and owes its activity prin- 
cipally to polygalic acid or senegin. 

What are its officinal preparations? 

Abstractum Senegae, dose gr. j-iv. 

Extractum Senegae Fluidum, dose nUj-v. 

Syrupus Senegas (about 1 part fluid extract in 6), dose 3j-ij. 

It is also present in the Compound Syrup of Squill (q. v.). 

What are its effects and uses? 

Locally, senega is an irritant, and^ in large doses may prove emeto- 
cathartic. In small doses it freely stimulates secretions generally, with 
a special action on the pulmonary mucous membrane. It is chiefly given 
as a stimulant expectorant in subacute and chronic bronchitis. In com- 
bination with the nauseant expectorants, as in syrup, scillae comp., 
which contains tartar emetic, it is sometimes prescribed in the acute 
stages. It has been used as an emmenagogue and diuretic. 

AMMONII CHLORIDUM (AMMONIUM CHLORIDE OR 

MURIATE). 

What are its properties ? 

Chloride of ammonium is formed by neutralizing gas liquor (water which 



166 EXPECTORANTS. 

has been used to wash burning gas, and contains the carbonate, hydro- 
sulphate, and sulphate of ammonium) with hydrochloric acid. It occurs 
in white, translucent, tough masses, odorless, but having a sharp saline 
taste. It is partially deliquescent, somewhat soluble in alcohol, and freely 
soluble in water. 

What are its effects and uses? 

Locally, this salt is an irritant to the skin and mucous membranes, and 
in large doses purges and occasionally produces emesis. After absorp- 
tion it is an alterative, diminishing the plasticity of the blood and in- 
creasing the urinary solids, with the exception of uric acid, which is 
somewhat diminished. It differs from other ammonium preparations in 
producing, in medicinal doses at least, very little circulatory effects, and 
in large doses it appears to be depressant. It exerts a selective action 
on mucous membranes, producing nutritive changes and epithelial exfo- 
liation. It is eliminated chiefly by the urine, but in small proportion by 
all the secretions. Muriate of ammonium is chiefly used in the later stages 
of acute and in chronic bronchitis. It it also used in muscular rheu- 
matism, neuralgias (especially in migraine and ovarian neuralgias), 
hepatic torpor, and good effects have been claimed for it in hepatic 
abscess. Dose gr. v-x three times daily, or for children gr. j-ij. For 
neuralgias large doses, gr. xx-xxx, repeated in an hour, are given. 

ALLIUM (GARLIC). 
What is allium ? 

Allium sativum is a ^ small perennial plant indigenous in Southern 
Europe and cultivated in this country. The bulb is the portion used. 
Its physical properties are too well known to require comment. It yields 
its virtues to water, vinegar, and alcohol, and owes its efficiency to an 
essential oil, which is very volatile and irritating. Garlic locally is irri- 
tant and rubefacient, and is used for these purposes externally. It is 
also claimed to be a cardiac and nervous stimulant. It is especially val- 
uable in the acute bronchitis of children, and has also been employed as 
an expectorant in subacute and chronic bronchitis, and as a stomachic and 
diuretic in other conditions. Its preparations are — 

Allium, dose 3ss-ij. 

Syrupus Allii, dose 3j-ij. 

BALSAMUM PERTJVIANUM. 

What are its origin and constituents? 

Balsam of Peru is obtained by incisions into the bark of Myroxylon 
Pareirce, a tree of Central America. It occurs as a thick, reddish-brown 
fluid of a pleasant odor and warm acrid taste. It is soluble in alcohol. 
It contains resin, an aromatic oil called cinnamein, and cinnamic and ben- 
zoic acids as its essential elements, and several other constituents. In 



BALSAMUM TOLUTANUM. TEREBENE. 167 

doses of gtt. x-xxx it is used as a stimulant diuretic in catarrhs of the 
respiratory tract, and to some extent in those of the genito-urinary tract, 
but is not nearly so much used internally as is the following drug. In 
surgery it has a distinct place as a stimulant application to sluggish 
granulations, although recently antiseptic properties have been denied 
it. It is given in emulsion. 

BALSAMUM TOLUTANUM. 

What is balsam of Tolu ? 

Balsam of Tolu is a balsam obtained from incisions into the bark of 
Myroxylon toluifera, also a Central American tree. It is at first a thick, 
viscid fluid, like balsam of Peru, but hardens with time into a resinous 
solid. It has a fragrant odor, a warm sweetish taste, and is quite soluble 
in alcohol and essential oils. Its composition, effects, and uses are prac- 
tically the same as those of balsam of Peru, but its more agreeable flavor 
renders it preferable to the latter for internal use. Its tincture and syrup 
are much used as vehicles. Of the former the dose is 3j-ij ; of the 
latter, §ss-j. 

PIX LIQUID A (TAR). 

Give the source, properties, and derivatives of tar. 

This familiar substance is derived by destructive distillation of various 
species of pine, chiefly Pinus palustris, the yellow pine of the South. 
Its physical peculiarities are well known. It is soluble in alcohol, ether, 
volatile oils, and fixed oils, and contains resin, oil of turpentine, etc. 
When distilled it yields pyroligneous acid and oil of tar (from which 
creasote is obtained), the residuum being pitch. The preparations are — 

Oleum Picis Liquidse, external use. 

Syrupus Picis Liquidae, 3j-ij. 

Unguentum Picis Liquidae, tar and suet, da. partes sequales. 

What are its effects and uses? 

Tar resembles the turpentines in action. Locally it is a decided stimu- 
lant, and in ointments and soaps is used in eczema, psoriasis, scabies, 
and other skin diseases. Its internal use may lead to some gastric irrita- 
tion, and in large doses to irritation of the kidneys and some increase of 
the urine. As the syrup or as tar-water internally or inhaled as a vapor 
it is employed as an expectorant in laryngitis and bronchitis. 

TEREBENE. 

What is this drug? 

Terebene is a colorless volatile oil, of a not unpleasant terebinthinate 
odor, formed by the action of strong sulphuric or phosphoric acid upon 
oil of turpentine. It is a valuable stimulant expectorant, and is em- 
ployed with good effect in subacute and chronic bronchitis, probably 



168 EMMENAGOGUES. 

acting on the broncho-pulmonary and genito-urinary mucous membranes 
much like oil of turpentine. It should be administered in emulsion or 
capsule in doses of Tt\,v-xv. 

TERPIN HYDRATE. 

What are its important properties? 

Terpin hydrate, also a derivative of turpentine, is a crystalline solid 
of very little taste and odor. Its effects, uses, and method of adminis- 
tration are the same as those of terebene, but it is probably inferior to 
that drug. 

EMMENAGOGUES. 

Emmenagogues are remedies employed to promote the menstrual dis- 
charge. Absence of this function, or amenorrhoea, may be dependent 
on or associated with a variety of constitutional conditions, as anaemia, 
plethora, constipation, wasting disease^ etc. , relief of which may bring 
on the menses. Drugs employed for this purpose are called indirect em- 
menagogues, and may be still further subdivided into tonic and purga- 
tive emmenagogues. Direct OT stimulating emmenagogues act, not, as 
in the case 01 blennorrhetics, specifically and appearing in the secretion, 
but by causing congestion of the pelvic organs. 

What are some important indirect tonic emmenagogues ? 

Ferrum. — Iron with its compounds is by far the most important 
member of this group. The association of amenorrhoea with anaemia is 
very common, and is the indication for the use of this drug. It is given 
in full doses, and it is often well to combine it with purgatives or stimu- 
lating emmenagogues. 

Manganum. — Manganese, either as the hinoxide or the permangan- 
ate of potassium, is employed in the same way as iron, and probably pro- 
duces similar effects, although some claims have been made that it 
directly stimulates uterine contraction — viz. that it is a direct emmena- 
gogue. Dose of either preparation, gr. j-ij. The binoxide is preferable, 
as it causes less gastric disturbance. 

Myrrha. — Myrrh has been employed for emmenagogue purposes, but 
its efficacy is doubtful. It is generally used in combination with iron or 
aloes. 

Name some purgative emmenagogues. 

Aloes. — This drug, as is shown under^ Cathartics, exerts a specific 
action on the peristalsis of the large intestine, and part of this irritation 
seems to be transmitted to the neighboring uterus. It is a useful em- 
menagogue in cases associated with constipation and atonic conditions 
generally. It is to be given in sufficient doses daily to produce a moder- 
ately laxative effect, and it is well to administer a large dose at the 
proper time for the menstrual period. When plethoric amenorrhoea 



SABINA.— PETROSELINUM. 169 

exists, which is probably but rarely, salines and depleting drugs are 
indicated. 

DIKECT OR STIMULATING EMMENAGOGUES. 

SABINA (SAVINE). 

What is sabina ? What is oleum sabinse ? 

Sabina is the dried tops of Juniperus Sabina, a small evergreen shrub 
of Southern Europe. Its activity depends upon an officinal volatile oil 
(oleum sabinse), which has a strong, peculiar, heavy odor and a burning, 
nauseous taste. 

What are its effects and uses ? 

Locally, savineis an irritant to the skin and mucous membranes. In 
medicinal doses it produces a feeling of warmth in the stomach, with 
perhaps nausea, and slightly stimulates the circulation and secretions. 
In doses large enough to be toxic the symptoms produced are those of 
acro-narcotic poisoning — viz. nausea, vomiting, purging, abdominal pain, 
suppression of urine, or hematuria, with such nervous symptoms as un- 
consciousness and at times convulsions. Collapse and death ensue. The 
lesions produced are those of gastro-intestinal inflammation. It has a 
very decided effect on the uterus, instituting or increasing its contractions, 
and in pregnancy may cause abortion. It is useful in amenorrhoea and 
menorrhagia when dependent upon a relaxed condition of the organs. 
The preparations are — 

Extractum Sabinae Fluidum, dose nuij-viij. 

Oleum Sabinae, dose ^j-v. 

Ceratum Sabinae, seldom used. 

RUT A (RUB ; not officinal). 

What are its constituents, effects, and uses ? 

Rue is the leaves of Ruta graveolens, or garden rue, a shrub of Europe. 
Its activity depends upon a volatile oil, oleum rutae, also non-officinal, and 
it also contains a neutral principle, rutin. It is a decided irritant, its ef- 
fects and uses resembling those of savine. It is also used somewhat as 
a carminative, an effect which it owes to its aromatic volatile oil. Dose 
of the oil, gtt, ij-v. 

PBTROSBLINUM (PARSLEY). 
What is apiol? 

Petroselinum sativum, or garden parsley, contains a volatile oil known 
as apiol or parsley camphor. This is a colorless or yellow oil, with a 
strong characteristic odor, non-saponifiable, soluble in alcohol, ether, and 
chloroform, but not in water. It has been successfully used in functional 



170 OXYTOCICS. 

amenorrhoea and neuralgic dysmenorrhea. Dose gtt. iij-vj, b. i. d., in 
capsule for three or four days previous to the expected menstrual period. 

TANACETUM (TANSY). 

What is it ? 

Tanacetum vulgare, the common tansy of the gardens, is sometimes 
employed in the form of a decoction ( t; tansy tea") or of its volatile oil 
as a stimulant emmenagogue, or more often for criminal purposes. It is 
a very unsafe remedy, sufficient doses causing symptoms of gastrointes- 
tinal irritation and epileptiform convulsions. 

POLYGONUM HYDROPIPEROIDES. 

What can you say of Polygonum hydropiperoides ? 

This drug, known also as water-pepper or smartweed, is an indigenous 
plant growing in moist places, and containing polygonic acid and other 
principles. It is a diaphoretic, diuretic, and expectorant, and in exces- 
sive doses a gastro-intestinal irritant. It is a stimulant emmenagogue 
and aphrodisiac, and has been emploved in functional amenorrhoea, and 
functional impotence, as well as in diarrhoea, dysentery, and for its diu- 
retic properties. 

Cantharides and other stimulating diuretics are also employed as era- 
menagogues. Combinations of iron, cantharides, aloes, and guaiac are 
favorite prescriptions for this purpose. 

OXYTOCICS. 

Define this term. 

Oxytocics are remedies used during or immediately after labor to ener- 
gize uterine contractions. Practically, the only drug used for this pur- 
pose is ergot, although similar powers are claimed for quinine and certain 
other remedies. 

ERGOT A (ERGOT). 

What is ergot? What can you say of its composition? 

Ergot is the sclerotium (intermediate stage of growth) of a fungus 
called Claviceps purpurea, replacing the grain of rye {Secale cereale), 
which is then known as u spurred rye" (Secale cornutum). The com- 
position of ergot is very complex, and the identity of its active principle 
has not been made out. It contains ecbolin, ergotin, ergotinin, ergotic, 
phosphoric, and sclerotic acids, and a variety of other constituents. 
Sclerotic acid is at present most likely to prove its active principle. 
Upon whatever it depends, ergot yields its activity to both water and 
alcohol, and ergotin, which is in reality nothing more than a watery ex- 
tract, represents the drug. 



ERGOT A. 171 

What are the preparations of ergot? 

These should be freshly made, as both the powder and its derivatives 
deteriorate decidedly by exposure : 

Ergota, powdered, dose 3ss-ij. 

Extractum Ergotae, dose gr. v-3ss. 

Extractum Ergotae Fluidum (most used), dose 3ss-§ss. 

Vinum Ergotae, 16 per cent., dose 3ij-,§ij. 

Ergotin, which is not officinal, is really an aqueous extract, and may 
be used when a solid preparation is desired. Bonjean's is best. Dose 
gr. iij-x. 

What are its physiological effects? 

To the therapeutist the chief interest lies in its effects upon the circu- 
lation and the uterus. Ergot induces contraction of unstriped muscle 
wherever found, with a specific action on that of the uterus and the in- 
testine. In the impregnated uterus ergot has the power of initiating 
contractions, and of greatly increasing their force when already begun ; 
while in the unimpregnated it also produces contractions, as is seen from 
the pain produced and its effect on hemorrhagic and other morbid 
processes of the uterus. 

Circulation. — Upon this function its effects are quite noticeable: it 
slows the pulse, probably by a direct action on the heart, and causes a 
contraction of the arterioles and a stimulation of the vaso-motor centre, 
which result in an immense increase of arterial pressure. In some cases, 
at least, the intestinal peristalsis is very greatly stimulated. 

What are the varieties of ergotism? 

Two varieties of poisoning may occur — acute and chronic, to the latter 
of which the term ergotism is applied. The symptoms of a single over- 
dose are those of aero-narcotic poisoning. The chronic form of poison- 
ing, or ergotism, results generally from eating ergotized grain, and has 
never occurred to any extent in this country, but epidemics of it occur 
from time to time in Europe. Two forms are recognized — convulsive and 
gangrenous ergotism. In either form the initial symptoms are generally 
identical — itching, formication, and other subjective sensations of the 
feet. Then in the convulsive variety symptoms of gastro-enteric irrita- 
tion appear, followed in a short time by violent and painful tonic contrac- 
tions of the flexor muscles, at first with intermissions, but later becoming 
more or less tetanic, and finally resulting in death from exhaustion. In 
the gangrenous form are added heavy feelings in the limbs, subjective or 
real coldness of the surface, anaesthesia, and finally an atrophic gangrene 
of the extremities or of the nose, ears, etc. 

In the acute poisoning seldom anything worse than abortion is pro- 
duced. When this is threatened, quiet, a recumbent position, and ner- 
vous sedatives are indicated. In the chronic form many die. 



172 OXYTOCICS. 

What are the uses of ergot? 

In obstetrical practice ergot is employed in the following conditions: 
Its most common use is in labor after the delivery of the placenta, to 
ensure full uterine contraction, the expulsion of clots, and to prevent 
post-partum haemorrhage. By some it is given as early as the second 
stage, but there is a possibility of its rendering the delivery of the 
placenta difficult. In uterine inertia small doses may be administered, 
it having first been ascertained that no mechanical impediment to a 
natural and speedy delivery exists either in the mother or the child. A 
dose of n\,v-xv of the fluid extract will intensify the uterine contractions, 
but not render them tetanic. The dangers of administering ergot before 
the delivery of the child are that it may set up a tetanic contraction of 
the uterus, which may result in its rupture or suffocation of the child 
by interfering with the placental circulation. 

Ergot is employed to arrest bleeding in a variety of conditions where 
no local measures are available, as in menorrhagia and metrorrhagia, 
whether from fibroids, endometritis, or other causes ; in the hemorrhagic 
diathesis combinations with digitalis and gallic acid will often prove valu- 
able ; also in purpura, epistaxis, haemoptysis, etc., but its efficiency is 
not great. In cerebral congestion, if hemorrhage can be positively ex- 
cluded — which in most cases is impossible — and in congestion of the spinal 
cord, it may give satisfaction, and should be administered in large doses 
(Sss-j of the fluid extract, t. i. d.). Some deny it any efficacy in both 
these conditions, and from the uncertainty of diagnosis in cerebral con- 
ditions its use in the former is probably unsafe. Ergot has also been 
used with asserted success in neuralgias, epilepsy, whooping cough, 
leucaemia, varicose veins, aneurism, and numerous other conditions. 

GOSSYPII RADICIS CORTEX. 

Of what importance is it ? 

This remedy, which is said to be used as an abortifacient by the negro 
women of the South, possess oxytocic properties which are probably 
feeble, and it has not come much into favor for that purpose. It has 
been used to some extent in amenorrhcea and dysmenorrhcea. The dose 
of the fluid extract is 3ss-ij. 

USTILAGO (CORN ERGOT). 

What are its source and properties? 

Ustilago maydis (corn smut or corn ergot) is a fungoid growth on Zea 
mays, or Indian corn. It occurs as irregular masses growing on all parts 
of the plant, but more frequently on the ears, composed of black gelat- 
inous matter enclosing dark nodular spores. Its odor is disagreeable 
and its taste unpleasant. It probably contains sclerotic acid, and its 
effects are supposed to be those of ergot, for which it has been sub- 
stituted. 



CIMICIFUGA. 173 

CIMICIFUGA. 

What are its source and component parts? 

Cimicifuga is the rhizome and rootlets of C. racemosa (black snake- 
root or black cohosh), an indigenous perennial plant. The active prin- 
ciple has not been isolated, but it contains a volatile oil, resins, a bitter 
principle, and tannic and gallic acids. 

What preparations are officinal? 

Cimicifuga, dose gr. xx-3j. 
Tinctura Cimicifugae, dose 3 s s-ij. 
Extractum Cimicifugse Fluidum, dose 3ss-j. 

What are its physiological effects ? 

The effects of this drug are not entirely clear. It resembles digitalis 
in its effect upon the circulation, and ergot upon unstriped muscle, but 
it is weaker in both respects. It increases the secretions of the skin, 
mucous membrane, and kidneys, and is supposed to have aphrodisiac 
and emmenagogue properties. 

What are its uses? 

This drug has been variously classed as an antispasmodic, expectorant, 
antirheumatic, and emmenagogue. In chorea its value is unquestion- 
able. As an expectorant it has been employed in chronic bronchitis. 
Furthermore, it has been employed as a diuretic in dropsies, a diaphoretic 
in acute rheumatism, and a cardiac tonic in fatty and dilated heart. It 
is useful in subinvolution of the uterus and in various nervous conditions 
reflexly dependent on menstrual difficulties, which it tends to correct. 

IRRITANTS. 

What are irritants ? and how are they classified ? 

Irritants are remedies employed to produce hyperemia or inflamma- 
tion of the parts to which they are applied. According to the intensity 
of their action they are divided into rubefacients, which simply produce 
redness of the skin ; vesicants or epispasiics, which cause an exudation 
of serum beneath the cuticle ; suppurants, which cause pustulation ; 
and eschar otics, which cause actual tissue-destruction. 

What is the rationale of their action ? 

The modus operandi of counter-irritants is not altogether clear. 
Clinical experience for ages, however, has shown their value, which 
probably depends upon some reflex effect upon the vaso-motor supply 
or the trophic nerves, by which the vascular supply of internal organs is 
modified and inflammatory processes are affected. 

What are the general indications for counter-irritants? 

These measures are used (1) for the relief of pain, either by an im- 



174 RUBEFACIENTS. 

mediate action upon the painful nerve or by affecting its blood-supply 
reflexly ; (2) to modify sthenic inflammatory processes ; (3) to promote 
absorption of serous accumulations, as in pleurisy, pericarditis, and 
chronic joint diseases ; and (4) to produce a general tonic effect upon the 
circulatory and nervous systems, as by mild counter-irritation by the 
actual cautery over considerable areas. 

When are they contraindicated ? 

Counter-irritants are not to be used in acute conditions characterized 
by high arterial and febrile excitement, lest they add to these by the gen- 
eral febrile disturbance they themselves cause : nor, again, in cases where 
decided asthenia exists, lest they produce a destruction of tissue, which, 
owing to the weakened condition, will not readily be repaired. 



RUBEFACIENTS. 

What conditions indicate these? 

This class of irritants is employed when a local analgesic effect is re- 
quired or a local stimulation of the capillary system, and also as mild, 
general, but not permanent, stimulants in depressed conditions of the 
system. It is as pain-allaying measures that they are particularly valu- 
able. When too long continued they may prove destructive to tissue — 
viz. epispastic or escharotic — and this is to be guarded against in asthenic 
conditions. 

SINAPIS ALBA (WHITE MUSTARD); SINAPIS NIGRA 

(BLACK MUSTARD). 

What is mustard ? 

Mustard is the seeds of two varieties of Sinapis, S. alba and S. nigra, 
both of which are natives of Europe, but are cultivated elsewhere. The 
seeds of the former are larger, of a yellowish color externally, and have 
a less pungent taste than those of the latter. 

How is the volatile oil formed ? 

The two varieties differ somewhat in composition. By the action of 
my rosin, an albuminous ferment, upon sinnigrin, a principle peculiar to 
black mustard, in the presence of water a very pungent volatile oil is 
formed. It does not pre-exist in the seeds. The white seeds yield no 
volatile oil, but by the action of the same ferment upon sinalbin, an acrid 
fixed principle is produced having somewhat similar properties. The 
activity of the ferment is checked by heat and acids, and somewhat by 
alcohol, so that cold, or at most tepid, water is the proper menstruum for 
both varieties. The volatile oil and the acrid fixed principle^ then, are 
the active constituents of the two varieties of seeds. 



CAPSICUM, PIX BUKGUNDICA. 175 

What are the preparations of sinapis ? 

Sinapis Alba is only used externally ; no officinal preparations. 
Sinapis Nigra, powdered, as emetic internally ; dose 3j-ij. 
Charta Sinapis. 

Oleum Sinapis Volatile, which is used only in Linimentum Sinapis 
Compositum. 

What are its effects and uses ? 

Internally, in small does, mustard is a stomachic and cardiac stimu- 
lant : in large doses it produces vomiting, while very large amounts cause 
gastro-intestinal inflammation. Locally, mustard is an irritant, the de- 
gree of its activity depending on the dilution in which it is used and the 
duration of its employment. These effects vary from those of a very 
mild rubefacient to vesication, and even the production of sloughing. 

Its internal use is for the most part limited to the production of emesis. 
(See Emetics. ) Locally, it is very much employed as a sinapism for mild 
cutaneous irritation in a variety of painful and inflammatory conditions 
too numerous to mention. It is an active irritant, but very easily con- 
trolled by judicious admixture with flour, Indian meal, or flaxseed. 

CAPSICUM (CAYENNE PEPPER). 

What is capsicum? 

This drug is the fruit of Capsicum fas tigiatum, a tropical and widely- 
cultivated plant. It contains fixed and volatile oils and a principle called 
capsaicin. 

What are its effects and uses? 

Locally, capsicum is an excellent rubefacient, and if its use is pro- 
longed it may vesicate. It is less used than mustard, because more dif- 
fusible and more apt to produce irritation of distant parts. 

Many other spices, as cloves, cinnamon, black pepper, ginger, etc., 
are used as counter-irritants, either alone or in some combination generally 
known as ' l spice plasters. 

PIX BURGUNDICA (BURGUNDY PITCH). 

What are its source and properties? 

Burgundy pitch is the resinous exudation from Abies excelsa, or Nor- 
way spruce, occurring in the shops as a yellowish, brittle substance, of a 
taste and odor resembling turpentine. At the surface temperature of 
the body, however, it is plastic and adhesive. 

What preparations does it enter into ? 

Emplastrum Picis Burgundicse, 90 per cent. , in yellow wax. 

Emplastrum Picis Burgundicge cum Cantharide, or ' ' warming plas- 
ter," which sometimes vesicates. It is also used as a basis for several 
other plasters. 



176 VESICANTS. 

What are its effects and uses ? 

Burgundy pitch is a gentle irritant, producing only mild inflammation 
and seldom vesicating, although at times a vesicular eruption may follow 
its use. In its various emplastra it is employed in chrome joint and 
pulmonary conditions and in muscular rheumatism, especially lumbago. 

PIX CANADENSIS (CANADA PITCH). 

Describe its source, effects, and uses. 

This is the prepared resinous exudation of Abies Canadensis, or hemlock 
spruce. It resembles the above in appearance, but is somewhat darker 
in color and possesses very little odor or taste. Its effects, which are 
due, as in Burgundy pitch, to a contained resin and volatile oil, and its 
uses, correspond to those of that drug, but it is softer at the body tem- 
perature and a less convenient application. Its only preparation is — 

Emplastrum Picis Canadensis, which is 9 parts pitch, with 1 part of 
yellow wax to give it consistency. 

Oleum Terebinthinae. — The use of turpentine stupes has already 
been spoken of. In stronger solutions oil of turpentine is a powerful and 
painful irritant. The preparations are — 

Oleum Terebinthinae, dose tttx-Jss. 

Linimentum Terebinthinae, " Kentish ointment. " 

VESICANTS. 

What are the general indications for vesicants ? 

The theory of their action has already been discussed. Their chief 
uses are (1) as derivatives or revellents for the cure of acute or chronic 
inflammation; (2) as analgesics ; (3) to promote absorption of collections 
of fluid ; (4) in nervous conditions to break up a train of morbid associa- 
tions ; and (5) for the cure of certain diseases of the skin. The drug 
most used lor vesication is 

CANTHARIS (CANTHARIDES). 

What is cantharis ? 

This drag, commonly known as Spanish fly, is a dried insect, Cantharis 
vesicatoria or Lijtta vesicatoria, found in Southern Europe. The odor 
of the insects is described as resembling that of mice, and their taste as 
acrid, burning, and urinous. They contain as their active principle cau- 
tharidin, which is odorless, tasteless, and insoluble in water, but ren- 
dered soluble in this menstruum by other constituents of the drug, so that 
cantharidin yields its virtues to water and also to alcohol. 

What are the preparations of cantharis ? 

Pulvis Cantharidis (seldom used), dose gr. j-ij. 
Tinctura Cantharidis, 5 per cent. , dose gtt. j-v. 



CANTHARIS. 177 

Ceratum Cantharidis, " blistering plaster," 30 per cent. 

Ceratum Extracti Cantharidis. 

Charta Cantharidis, ' c blistering paper. 

Linimentum Cantharidis, 1 part canth. , 7 of ol. terebinth. 

Collodium cum Cantharide, about 50 per cent, cantharides. 

Emplastrum Picis Burgundicse cum Cantharide (warming plaster) con- 
tains 8 parts of cerate of cantharides and 92 parts of Burgundy pitch. 

With the exception of the tincture these preparations are all used for 
blistering. This takes place in from six to eight hours. " Cantharidal 
collodion ' ' is easily applied, and is valuable in refractory patients because 
not easily removed. 

What physiological effects does it produce ? 

Locally to the skin, in which way it finds its chief use, cantharis is 
an active irritant, causing redness, burning pain, vesication, and, if too 
long maintained, even sloughing of the deeper tissues. Its effects upon 
the mucous membranes are similar, and when ingested in large doses it 
causes violent gastro-enteritis. The drug is eliminated by the kidneys, 
and there again proves irritant, in small doses increasing the amount of 
urine, and perhaps causing some pain on urination, while large doses may 
be followed by hematuria, strangury, priapism, intense erotic desire, and 
excruciating pain. The aphrodisiac effect is not constant. Cantharis 
is freely absorbed from its own blister, and when so used may cause these 
symptoms, and should be employed with care when any kidney lesion exists. 

What are the symptoms, lesions, and treatment of toxic doses ? 

The effects of toxic doses are briefly stated : severe g astro-enteric and, 
genito-iirinary irritation. The treatment consists in evacuation of the 
stomach, if this has not already taken place, and the administration of 
opiates' and demulcents, avoiding, however, all oily substances, in which 
cantharidin is easily soluble : 20 grains are said to have proved fatal. 
The lesions after death are those of intense inflammation of the entire 
alimentary tract and an acute desquamative nephritis. 

What are its therapeutic effects? 

Its occasional use as a diuretic and emmenagogue has already been 
noted. Locally, it is a favorite, and, in fact, the most efficient, method 
of producing vesication, and is used to fulfil any of the indications for 
blistering which may arise, bearing in mind the possibility of its causing 
genito-urinary irritation in patients with renal disorder. 

Cantharis vittata, or potato fly, and other varieties of Cantharis are 
used as substitutes for Cantharis vesicatoria. They contain cantharidin 
and possess similar properties to the officinal drug. 

Aqua Ammonise Fortior. — This drug, applied to the skin on flan- 
nel or under a watch-glass to prevent evaporation, will produce vesica- 
tion very quickly (five to ten minutes), but it is extremely painful, and 
should seldom be used except in an emergency. 
12— M. M. . 



178 ESCHAKOTICS. 

ES0HAROTI0S. 

What are the general indications for their use ? 

Escharotics, caustics, or cauterants are drugs employed to destroy the 
structure or vitality of tissues. They are employed ( 1 ) to effect the re- 
moval of morbid growths, as warts, condylomata, lupus, cancer, etc. ; 
(2) to destroy as far as possible the virus in wounds made by rabid or ven- 
omous animals; (3) to cure violent inflammations, as in gonorrhoea, 
ophthalmia, malignant pustule, etc. ; and (4) to stimulate indolent ulcers 
and sinuses. They vary greatly in the character and intensity of their 
action, from the production of a mere film, as by lunar caustic, to the 
widely destructive action of some members of the group. 

ARGENTI NITRAS FUSUS. 

What is the peculiarity of its action ? 

This preparation, which has already been described, does not liquefy, 
and so affects the tissues to which it is applied only superficially and 
forms a protecting pellicle over them. It is very frequently used to 
stimulate granulations and destroy them when exuberant, and in a great 
variety of inflammatory conditions. 

POTASSA. 

What is caustic potash? 

Caustic potash is prepared by evaporating liquor potassae. When 
fused it is cast in moulds, forming sticks of a grayish or brown color, 
very deliquescent, and having a caustic, saltish taste. These contain cer- 
tain impurities which are insoluble in alcohol, while potassa itself is 
freely soluble in this menstruum and in water. In this way a pure white 
salt is obtained, known as alcoholic potassa. 

What are its effects and uses ? 

Potassa is a very powerful caustic. When applied to the skin it melts, 
abstracts the water from the tissues, and forms a dirty, grayish slough 
which is very permeable, so that its action extends to a considerable 
depth. It causes great pain. It may be used to meet any of the indi- 
cations for the more powerful cauterants, as in the destruction of chan- 
cres, poisonous bites, malignant pustules, lupus, rodent ulcers, and 
epithelioma. 

Potassa cum calce, or potassa with lime, contains equal parts of these 
ingredients. It occurs in sticks or in an alcoholic paste called "Vienna 
paste." It is milder, less deliquescent, and more easily limited than 
potassa, and is more often used. 



CAUSTIC SODA. — BROMUM. 179 

CAUSTIC SODA. 

How is it similar to, and how different from potassa ? 

Caustic soda is prepared in an analogous way to potassa. Its physical 
properties are also for the most part similar, but it is less translucent, 
and, although deliquescent, it does not remain permanently liquid, but 
after a time effloresces. c v London paste ' ' is equal parts of caustic soda 
and lime. The uses of caustic soda are the same as for Potassa. 

ACIDUM ARSENIOSUM. 

What can you say of its cauterant effects ? 

Arsenic has already been described at length. It remains only to con- 
sider its action and uses as a caustic. Applied to the tissues, it is a very 
powerful but slow and extremely painful escharotic, producing intense 
inflammation of surrounding tissues. It affects the tissues as an irritant, 
destroying their vitality, rather than in a chemical manner. Absorption 
of a serious nature may take place from a raw surface. However, the 
more freely it is applied the less the danger of absorption seems to be, 
and when used over areas of any size it must be used freely. Various 
pastes and ointments have been employed, varying only in the substances 
used to render its effects milder and less painful. It is occasionally used 
in lupus, epithelioma, and other dangerous conditions. 

ZINCI CHLORIDTJM. 

What are the advantages of chloride of zinc as a caustic ? 

The chloride of zinc is only slightly less powerful than potassa, and 
seems to possess to a degree the power of disinfecting its own slough, 
so that the subjacent tissues are left in a healthy granulating condition 
after the slough separates. Its use is free from danger as regards ab- 
sorption. The indications for its use are those mentioned under Potassa, 
and it is also an excellent stimulant to sluggish ulcers and sinuses. 

In what form is it used ? 

It may be employed in an alcoholic or a watery solution, in both of 
which it is freely soluble ; but it is more generally used as Canquoin's 
paste, which is made by mixing it with equal parts of wheaten flour with 
a little water : varying proportions, however, of the chloride are used 
according to the condition in harid. 

BROMUM. 

What are the properties of bromine ? 

The element bromine is a dark-red liquid, volatilizing in exceedingly 
pungent fumes, which are very irritating to the broncho-pulmonary mu- 



180 ESCHAROTICS. 

cous membrane. It is caustic to the taste and of a disagreeable odor, 
and is freely soluble in ether, less so in alcohol and water. 

What are its effects and uses? 

It affects the tissues chemically, decomposing hydrogen compounds 
and forming hydrobromic acid. Owing to its liquid form and volatility 
it is a rapid and thorough caustic, and possesses deodorant and disinfect- 
ant properties. It is seldom used as a caustic, the occasion for its use 
being limited chiefly to hospital gangrene and carcinoma uteri. In weak 
solutions it may be inhaled in small amounts in offensive catarrhal con- 
ditions, as ozsena. 

ACIDUM CHROMICUM. 

What are its source and properties? 

Chromic acid (chromic anhydride) is made by the addition of sulphuric 
acid to a solution of potassium bichromate. It occurs in deep-red, needle- 
form crystals, easily deliquescing to a deep-red liquid, and very soluble 
in water, forming an orange -yellow solution. 

What are its effects and uses ? 

Applied to living tissues, it rapidly oxidizes and decomposes them, its 
cauterant action being very active, but less painful than other members 
of this group. Internally, it is a violent corrosive poison, and death has 
taken place from absorption following its external use. It finds its chief 
use in the hands of the dermatologist for the destruction of syphilitic 
condylomata and other dermal growths. 

What dangerous combinations should be avoided ? 

When mixed with easily oxidizable substances, as strong alcohol, gly- 
cerin, etc., it is liable to cause combustion, or even an explosion, so great 
is its oxidizing power. 

HYDRARGYRUM. 

What preparations of mercury are caustic ? 

Hydrargyri chloridum corrosivum (corrosive sublimate) in saturated 
solutions may be used as a mild caustic in chancroidal and other condi- 
tions. It is less powerful in its action than liquor hydrargyri nitratis. 
This preparation is made by dissolving Hg or its red oxide in an excess 
of nitric acid. It contains free nitric acid, and is a clear, acid, highly 
corrosive liquid, and is said to possess peculiar efficacy in syphilitic con- 
ditions. 

ACIDUM NITRICUM. 

What are its uses ? 

Nitric acid is a powerful caustic, useful for the cauterization of small 
areas. It is applied with a glass rod or a splinter of wood, as it attacks 



SUPPURANTS. — IRRITANTS. 1 81 

and destroys most metallic substances. It is very penetrating, a drop or 
two being sufficient. When enough tissue has been destroyed it is lim- 
ited in its action by neutralizing it with an alkali. Like that of other 
mineral acids, unless this be done its action is apt to extend beyond the 
point of application. 

What other acids are employed for this purpose ? 

Sulphuric, hydrochloric, and the stronger and glacial acetic acids are 
also caustics of a varying degree of activity, but, with the exception of 
glacial acetic, are seldom used for this purpose. The sulphates of zinc 
and copper and dried alum are employed as mild caustics to exuberant 
granulations. The actual and galvano-cauteries are much used for this 
purpose. 

SUPPURANTS. 
What two drugs may be so classed? 

Oleum Tiglii.— Croton oil, applied with friction to the skin, pro- 
duces an inflammation ^ accompanied by a pustular eruption. For pur- 
poses of counter-irritation it is applied either undiluted or mixed with 
one or two parts of olive oil or oil of turpentine to the chest in chronic 
bronchitis and allied conditions, and to rheumatic joints. 

Unguentum Antimonii. — This preparation produces effects similar 
to those of oleum tiglii, and may be used in similar conditions, but is a 
more painful application. 

IRRITANTS. 

Under this subdivision may also be considered two drugs which, 
although they do not possess vesicant, rubefacient, or escharotic action, 
are much used by the dermatologist. 

Sapo Viridis (green or soft soap) ; — Green soap is prepared from 
potassa and the fixed oils, and is chemically a combination of the oleate, 
stearate, and palmitate of potash. It is a soft, greenish soap of the 
consistency of jelly, and is very soluble in water and alcohol. Owing to 
the potassa it contains it is an irritant, and constitutes an invaluable 
preparation for local application in the scaly skin diseases, as in the scaly 
forms of eczema, and in scabies. As an alkali it is an efficient antidote 
to acid-poisoning, and possesses the advantage of being generally avail- 
able. Too long continued, it may produce decided irritation of the skin. 

Chrysarobirmm. — Chrysarobin is an orange-colored, tasteless, odor- 
less, and crystalline powder, insoluble in water, slightly soluble in alcohol, 
and freely soluble in ether. It is a mixture of principles extracted from 
goa-powder, which is found in the wood of Andira araroba, a Brazilian 
tree, and is present also in Rheum officinale and other varieties of 
rhubarb. 

Effects and Uses. — Its internal effects are disputed, but gr. v-vij prove 
purgative. Applied to the skin, it produces a yellow stain, causes irri- 



182 DEMULCENTS. 

tation, with at times oedema and a furuncular inflammation. In tjie 
treatment of psoriasis it is a specific, and it is also employed with success 
in the other scaly skin diseases. The officinal (10 per cent.) ointment 
often proves too irritant for the skin, and has to be diluted with one or 
two parts of some simple ointment. 

DEMULCENTS. 

What are demulcents? 

Demulcents are substances, consisting chiefly of gum or mucilage, 
which soften and relax the tissues and diminish the heat, tension, and 
pain of inflamed areas. As most of them contain sugar and starch, 
their constitutional effects are chiefly nutritive. They are employed in- 
ternally to relieve severe gastro-intestinal irritation, as after the ingestion 
of irritant poisons or other acute inflammations ; to affect reflexly slight 
bronchial inflammations, and locally those of the pharynx and larynx ; 
and as light diet for the sick. Externally, they are extensively employed 
to relieve the symptoms of burns, wounds, etc. , while in pharmacy they 
are much used to suspend substances insoluble in water. A very com- 
mon form for external use is the poultice or cataplasm, which consists of 
these mucilaginous and starchy substances made into a soft consistency 
with water. They form a convenient method for the application of heat 
and moisture, and have already been sufficiently considered. 

AQUA (WATER). 

What are its uses ? 

Water fulfils important dietetic, medicinal, and pharmaceutical uses. 
It aids in the solution and digestion of food, the metamorphosis and 
construction of tissue, and is said to increase the total solids eliminated 
by the urine. It is the best of demulcents, and as such is much used. 
The ingestion of too large amounts, however, causes disturbances of 
digestion. For pharmaceutical purposes distilled water (aqua destillata) 
should alone be employed. 

ACACIA (GUM ARABIC). 

What are its source and principal ingredient ? 

Acacia is a gummy exudate from Acacia verek and other species of 
Acacia, a small African tree. Several varieties of gum Arabic are 
known, all of which are somewhat transparent, hard, and pulverizable. 
They are odorless, and have a somewhat sweetish taste. They are almost 
wholly made up of arabm, which is soluble in water, forming mucilage, 
from which solution it is precipitated by alcohol. 

What are its effects and uses ? 

Gum arabic is not digestible, and its only effect is that of a demulcent, 



TRAGACANTH A . — UL.MTJS. 183 

for which it is used in gastro-intestinal conditions, as diarrhoea, dysentery, 
acid-poisoning, etc., and as a lubricant in catarrhal affections. It is 
much used as a vehicle for anodynes and expectorants in cough mixtures. 
The following preparations are officinal : 

Pulvis Acacise, ] 

Mucilago Acaciae, > used as vehicles ; dose ad lib. 

Syrupus Acacige, J 

TRAGAOANTHA (TRAGACANTH). 
What is this drug ? 

Tragacanth is a gummy exudation from Astragulus gummifer and 
other varieties of Astragalus, small shrubs of Asia Minor. It occurs in 
odorless and nearly tasteless flakes, and when heated and water added it 
swells up and forms a paste without actual solution. Its chief con- 
stituents are arabtn (or a similar substance) and tragacanthin. Its 
chief use is for suspending heavy insoluble powders and to give a proper 
consistency to lozenges. 

Tragacantha and Mucilago Tragacanthae are officinal. 

CETRARIA (ICELAND MOSS). 

What is cetraria? 

Cetraria, or Iceland moss, is a lichen, Cetraria Islandica, chiefly 
obtained from Iceland and Norway. It contains a starch, lichenin, and 
a bitter principle, cetrarin. It imparts its bitterness to cold and all its 
virtues to boiling water. It is a highly nutritious demulcent, and may 
be used in jelly, the bitter principle having first been removed by soak- 
ing in cold water. 

CHONDRUS (IRISH MOSS OR CARRAGEEN), 

What can you say of chondrus ? 

Irish moss consists of the fronds of Chondrus crispus, a sea- weed 
found on the coast of Ireland and the Northern United States. Its 
active principle, carrageenin, is a substance somewhat resembling starch, 
but not giving the characteristic iodine reaction. Boiled in water, it 
yields a solution which gelatinizes on cooling. It is a nutritious demul- 
cent, and is given as an article of diet to the sick in the form of decoc- 
tion with suitable flavoring, or with milk as blanc mange. 

ULMUS. 

What are its points of interest ? 

Ulmus, or slippery elm, is the inner bark of Uhnus fidva, an indig- 
enous tree. It contains a large amount of mucilaginous matter and 
some tannic acid, and has found employment in catarrhs of the intestinal 



184 DEMULCENTS. 

and genitq-urinary tracts. It possesses considerable nutritive value as 
well, and it is used externally in poultices. 

Mucilago Ulmi is officinal, and is used as a demulcent drink. 

GLYCYRRHIZA (LICORICE). 

What are its sources, constituents, and uses? 

Licorice is the root of Glycyrrhiza glabra, a plant of Southern 
Europe. Its long fibrous roots have no odor, but a sweet mucilaginous 
taste, which they owe to a glucoside, glycyrrhizin, soluble in boiling 
water and alcohol. Licorice is used as a demulcent and as a flavoring 
agent to disguise the taste of unpleasant drugs. The cortex of the root 
is acrid and possesses no demulcent properties. It has many prepara- 
tions : 

Extractum Grlycyrrhizse, ] 

Extractum Grlycyrrhizse Purum, > used as flavoring agents. 

Extractum Grlycyrrhizge Fluidum, J 

Trochisci Grlycyrrhizae et Opii ; each contains opium gr. ■£$. 

Pulvis Glycyrrhizse Compositus. See Senna. 

Mistura Glycyrrhizae Composita (brown mixture), a favorite vehicle for 
cough mixtures ; contains extr. glyc. purum, acacia, sugar, spt. aetheris 
nitros. da. 3 parts, paregoric 12 parts, wine of antimony 6 parts, with 
water to 100 parts. 

LYCOPODIUM. 

What are the uses of lycopodium ? 

This drug consists of the sporules of L. clavatum, or club-moss, and 
other varieties of Lycopodium, plants of Europe and America. It 
occurs as a fine yellow powder, which is much used as a dusting powder, 
not being moistened by water. It is also used in pharmacy to prevent 
pills from adhering together. 

LINUM (FLAXSEED). 

What does flaxseed contain? 

The seeds of Linnm usitatissimum, or common flax, contain large quan- 
tities of mucilage and oil (oleum lini). It is the most common basis for 
poultices, and is used internally as a demulcent, sometimes in infusion, 
but preferably in decoction. 

AMYLUM. 
What are its sources and chemical properties? 

Amylum, or starch, is officinally the ' fcecula of Tritieum vulgare, or 
wheat, but is, as is well known, a proximate principle found in a large 
variety of plants throughout the vegetable kingdom. It is a carbo- 
hydrate (C 6 H 10 O 5 ). By boiling it with dilute sulphuric or hydrochloric 



EMOLLIENTS. — LAXOLIXE, GLYCEEINEM. 185 

acid it is converted into an isomeric principle, dextrin, and this in turn 
into glucose^ or grape-sugar. 

What are its effects and uses ? 

The starches are an important group of nutrients, the consideration 
of whose physiological history falls more properly elsewhere. It is used 
as a dusting powder, as a constituent of poultices, and is the antidote for 
iodine. 

Mention other demulcents. 

Other drugs possessing similar qualities are — 

Althaea, the roots of AUhoea ills. 

Cydoniura, seeds of C. vidgart. or quince: mucilage officinal. 

Sassafras Medullas or sassafras iw>A. 

EMOLLIENTS. 

Emollients are bland substances, principally of a fatty nature, which 
are used externally to soften the skin and render it pliable. 

LANOLINE. 

Has it any advantages? 

Lanoline is a fat constituting about 45 per cent, of the wool of sheep. 
and consisting of the secretion of the sebaceous follicles. It contains 
cholesterol. When first introduced the property of being quickly ab- 
sorbed, together with that of impregnating substances, was claimed for 
it. but recent experiments have apparently disproved this. 

GLYCERINUM. 

What can you say of its manufacture and uses ? 

Glycerin, which is chemically propenyl alcohol, is liberated from its 
combinations with the fatty acids (stearic, niargarie. oleic, etc. during 
the process of saponification, when these acids unite with an alkali. In 
this form, however, it is impure and apt to be irritant. The purest and 
blandest forms are derived from this soap- waste by a patented process, 
but the largest amounts are made by passing superheated steam through 
fats. Glycerin is a thick, colorless liquid, with a sweet, slightly burning- 
taste. It mixes in all proportions with alcohol, oils, and water, and is 
itself a solvent for iodine, bromine, tannic and vegetable acids, saliein. 
and many neutral salts, etc. It is very hygroscopic and does not evaporate. 

The use of glycerin as a nutrient and alterative has now been abandoned, 
and it is chiefly used topically. Either in its own form or in combina- 
tions in various creams it is employed in chapped skin, excoriations, 
sehorrhcea. and other skin diseases. Even in its purest forms it is irri- 
tant to some skins. For a similar emollient effect upon the mucous mem- 
branes it is used in coryza and laryngitis. Internally, it exerts a mSd 



186 EMOLLIENTS. 

laxative effect, but its chief use is to disguise the taste of unpleasant 
medicines, as castor oil, turpentine, iron solutions, etc. ; also as a substi- 
tute for sugar in diabetes, but it possesses no curative properties. 

SACCHARIN. 

Its properties and uses ? 

Saccharin is a complex, white, crystalline, intensely sweet powder, 
slightly soluble in water, with which it forms an acid solution, and 
readily soluble in glycerin, alcohol, and ether. Even in large amounts 
it produces no marked physiological effects. It is chiefly of use where 
sugar is contraindicated for any reason, as in diabetes or obesity. It 
acidifies the urine and prevents decomposition, and may be used with 
advantage in conditions where the urine is ammoniacal, as from cystitis, 
etc. 

PETROLATUM. 
What is it ? 

Petrolatum is a yellowish, translucent, semi-solid mixture of substances 
of the marsh-gas series. It is obtained by distilling off the more volatile 
parts of crude petroleum and purifying the residue. It is insoluble in 
water and alcohol, but readily soluble in ether, chloroform, oil of turpen- 
tine, and the fixed and volatile oils, and melts at a temperature of 1 05° 
to 125° F. It is similar to various proprietary substances, as vaseline, 
cosmoline, etc., and was introduced as a substitute for them. Paraffin 
is the basis of all these preparations. 

What advantages does it possess ? 

The advantages of these hydrocarbon oils consist in their freedom 
from odor and acridity and their lesser liability to become rancid. 

What are its effects and uses ? 

Petrolatum in any ordinary dose does not produce physiological effects. 
Its chief use is as a protective external application and as a basis for oint- 
ments. 

What other substances are used for similar purposes ? 

Adeps (lard), a mild fat melting at the body temperature and largely 
used in pharmacy, often as adeps benzoinatus, which contains 2 per cent, 
of benzoin. 

Oleum Theobromse (cacao butter), a fixed oil expressed from the 
seeds of Theobroma cacao, a tropical plant of South America : it is a 
bland vegetable fat, solid at ordinary temperatures, but melting at that 
of the body, and is much used in suppositories. 

Cetaceum (spermaceti), a concrete fatty substance obtained from the 
sperm whale : used to give consistency to ointments. Ceratum 
cetacei contains spermaceti 10, white wax 35, and olive oil 55 parts. 



PROTECTIVES. — GUN-COTTON, GUTTA-PERCHA. 187 

Cera alba (white wax) and Cera flava (or yellow wax) are both 
used for the same purposes as spermaceti. 

PROTECTIVES. 

What are protectives? 

The name ' ' protectives ' ' is applied to a class of remedies which are 
used medicinally to exclude the air from and protect inflamed super- 
ficial tissues. 

GUN-COTTON. 

What is gun-cotton? 

Pyroxylinum, or soluble gun-cotton, is made by macerating cotton in 
a mixture of nitric and sulphuric acids, and afterward washing with 
water and drying. The officinal pyroxylin is not so highly nitrated as 
other varieties of gun-cotton, and is more soluble. It resembles ordinary 
cotton in appearance, but is harsh to the touch. It is used in medicine 
only in making collodion. 

COLLODIUM (COLLODION). 

What are its physical properties, varieties, effects, and uses ? 

Collodion is a colorless, syrupy liquid with a strong odor of ether. 
It consists of pyroxylin 4,^ stronger ether 70, and alcohol 26 parts. 
When applied to the dry skin the menstrua quickly evaporate, leaving 
a thin, flexible, and very contractile film. It may be used as a protective 
to wounds and bed-sores or for the coaptation of the edges of incised 
wounds. It is also valuable for the solution of medicinal substances, as 
cantharides, capsicum, etc. when these are applied locally. When it 
contains tannic acid it is called collodium stypticum. 

Collodium flexile, or flexible collodion, contains castor oil 3 and Canada 
turpentine 5 parts, and shrinks very little on drying — a decided advantage 
in many cases. It is slightly irritant from the turpentine. 

Cantharidal collodion has already been considered under Epispastics. 

GUTTA-PERCHA. 

What are its points of interest ? 

Gutta-percha is the concrete exudation of Isonandra gutta, an East 
Indian tree. A 9 per cent, solution in chloroform is officinal as liquor 
gutta-perchse, and when applied to the skin forms a thin adhesive film 
which constitutes an elegant protection for small cuts, fissures, etc. in 
domestic practice. 

Mention some other protectives. 

Certain plasters, as Emplastrum Resinae, Emplastrum Plumbi, 
Emplastrum Saponis, etc., are also used as protectives to denuded 



188 ANTACIDS. 

surfaces. They should be spread upon very soft kid, and should be 
fresh enough not to have lost their plasticity. 

ANTACIDS. 

What are antacids ? 

Antacids are remedies employed to neutralize excessive acidity of the 
gastric and intestinal contents. This acidity may be due to hypersecre- 
tions or to fermentation of undigested food. In a wider sense antacids 
are substances which enter the blood, increasing its alkalinity and that 
of the secretions. The alkalies and alkaline earths and their carbonates 
are included in this class. Given before the ingestion of food, alkalies 
increase the acid secretion; after meals, they help to neutralize this 
acidity. For the former purpose smaller doses are given than for the 
latter. 

•SODIUM. 

The arseniate, bromide, nitrate, phosphate, sulphate, and many other 
sodium salts having peculiar effects due to these constituents have already 
been mentioned. 

What preparations of soda are antacids ? 

The following salts will here be considered : 

Liquor Sodae, a colorless, unpleasant-tasting liquid, containing about 
5 per cent, of sodium hydrate. 

Sodii Carbonas (carbonate of soda) occurs as colorless crystals, efflores- 
cing to a white powder and very soluble in water. 

Sodii Carbonas Exsiccatus, which is formed by heating the carbonate 
and driving off its water of crystallization. 

Sodii Bicarbonas, prepared by saturating solutions of the carbonate 
with C0 2 , occurs in white, opaque, permanent crystals, odorless and of 
a cooling saline taste and slightly alkaline reaction. Soluble in 12 parts 
of water and insoluble in alcohol. 

What are the effects and uses of the carbonate and bicarbonate ? 

These salts maybe employed as antacids, antiplastics, and diuretics: 
they are less irritant and more palatable than the corresponding potas- 
sium salts. Of the two, the bicarbonate is the less irritant and more 
agreeable, and is used in many effervescing mixtures. Locally, it is a 
valuable domestic remedy, as ordinary baking soda, for burns, scalds, 
and the bites of insects. 

CALX (LIMB). 

What are the different properties of slaked and unslaked lime ? 
Unslaked lime is a powerful corrosive, and is used in Vienna paste 
(potassa cum calce). Slaked lime possesses properties due to its alka- 
linity and slight astringency. 



LIQUOR CALCIS. — SYRUPUS CALCIS. 189 

LIQUOR CALCIS. 
What is it? 

Lime-water is a saturated solution of lime containing 15 per cent, of 
calcium hydrate. It is colorless, odorless, and of a somewhat disagree- 
able alkaline taste. Unless kept tightly corked it absorbs C0 2 from the 
atmosphere, and calcium carbonate is precipitated. 

What are the effects and uses of lime-water ? 

It combines antacid and astringent properties. Internally, it is used 
in cases of gastric irritability, small amounts of milk and lime-water in 
varying proportions being a valuable and frequently used remedy for 
checking vomiting. It is also of value in diarrhoeas of fermentative 
origin, and is suitable as an antidote for poisoning by acids, as sulphuric 
and oxalic. Externally, it is used in certain skin diseases, prurigo, scabies. 
and especially tinea capitis, and as an injection in leucorrhxea and gleet. 
Inhaled or administered by atomization. it will dissolve diphtheritic exu- 
dations. 

Linimentum Calcis. or Carron oil. is an invaluable soothing applica- 
tion to relieve the pain of recent burns. 

SYRUPUS CALCIS. 
Why is it particularly efficient? 

Lime dissolves more readily in syrup than in water, and the syrup con- 
tains about 5 per cent. It is twenty-four times as strong as lime-water, 
and is a useful astringent in diarrhoeas. It may be used as an antidote 
in poisoning by carbolic or oxalic acid, but is not the best. Dose 5ss-ij. 

Calcii Carbonas (calcium carbonate or chalk) is a native product 
of physical properties too well known to require description. It is insol- 
uble in water, but soluble in dilute hydrochloric acid. 
_ Creta Praeparata (prepared chalk), made from the above by leviga- 
tion and elutriation. a white, perfectly smooth powder, generally dis- 
pensed in small cubic cakes ; dose gr. x-xxx. 

Calcii Carbonas Praecipitatus, formed by the reaction of cal- 
cium chloride and sodium carbonate, and existing as a white, smooth 
powder ; dose gr. x-xxx. 

What are the effects and uses of these preparations ? 

_ Prepared chalk and the precipitated carbonate possess similar proper- 
ties and equal efficiency. They act as antacids and slight astringent*. 
and form very valuable remedies in diarrhoeas where an antacid is indi- 
cated. They are also used in dyspepsia, the gouty diathesis, and in 
rachitis. Externally, they are employed as desiccants and protectives to 
excoriated surfaces. 

What other antacids may be mentioned? 

The preparations of potassium, the effervescing preparations of mag- 
nesium, and the aromatic spirit of ammonia are often used as antacids. 



190 ANTISEPTICS, DISINFECTANTS, GERMICIDES. 

ANTISEPTICS, DISINFECTANTS, GERMICIDES. 

Define these terms. 

Disinfectant and antiseptic are terms which for the most part are used 
interchangeably. Antiseptics are substances which prevent putrefaction 
or septic decomposition. Germicides are remedies which destroy disease- 
producing germs or their spores. The same substances may thus be both 
antiseptics and germicides, depending on their concentration. All germ- 
icides are necessarily antiseptics, but not all antiseptics are germicides. 

What are the necessary conditions for putrefaction, etc. ? 

Putrefaction ordinarily, and the septic processes of human pathology 
as well, require certain conditions for their development: (1) Organic 
substances capable of easy disintegration ; (2) certain conditions of heat, 
air, and moisture ; (3) certain ferments, which in most cases are living- 
organisms, generally vegetable. If any of these conditions are wanting, 
these processes cannot take place. Thus, it is well known that extreme 
cold, the exclusion of air as in the domestic process of canning, and a 
very dry atmosphere will prevent or delay putrefaction. So, again, the 
destruction or exclusion of the ferments will produce the same effect ; 
and it is here that the drugs and measures of this class find their field. 

Name some physical disinfectants. 

The most potent agent of this sort is fire, and by it contaminated 
clothing, etc. may be disposed of. Next in power, and first in import- 
ance, are air and water, which act as potent oxidizing agents. Free dilu- 
tion of a poisoned atmosphere with pure air is all-important, and is our 
main reliance in rendering safe infected rooms and wards. 

CALX (LIMB). 

What is its value as a disinfectant? 

Lime is a destructive agent, causing a slow oxidation of organic mat- 
ter. Oxidation is, as we have seen, a valuable means of disinfection. 
Lime is much used for disinfection of sewage, etc., but of late it has 
been claimed to have disadvantages, in that it causes the evolution of 
volatile gases which may carry noxious matter with them. It is an ab- 
sorbent. Other uses of lime have been noted. 

OZONE. 

Ozone (0 3 ), an allotropic form of oxygen, is a powerful oxidizer. It 
is present in small proportion in the atmosphere, and undoubtedly is an 
important factor in Nature's antiseptic processes, but has not yet taken 
rank as a practical antiseptic. It is at present much used for the relief 
of distressing dyspnoea, as in asthma, pneumonia, etc, 



HYDROGEN PEROXIDE. CORROSIVE SUBLIMATE. 191 

HYDROGEN PEROXIDE. 
What are its chemistry and uses? 

This compound (dioxide of hydrogen, H 2 2 ) gives up its oxygen easily, 
and is dispensed in a watery solution, slightly acidulated with HC1 to 
give it stability, and yielding from 10 to 15 volumes of oxygen gas. It 
decomposes at a temperature of 60° R, and must be kept in a cool place. 
It is a powerful oxidizing agent and germicide, coagulating albumin, but 
not very irritant. It has been used to some extent internally, but its 
chief value is in suppurating conditions of the ear, mouth, pleural cavity, 
etc. , and in inoperable sinuses generally, in which it acts as a stimulant 
antiseptic. 

POTASSII PERMANGANAS. 
What is the nature of its antiseptic properties ? 

This drug, already mentioned elsewhere, contains a large amount of 
readily available 25 to which it owes its antiseptic power. It is a pow- 
erful antiseptic, but of very short duration, being quickly deprived of its 
oxygen and rendered inert. As a practical germicide its value is not 
great, because the organic matter in which the noxious elements are 
present so quipkly deprives it of its oxygen. It is a good deodorizer, 
and is of considerable service, locally, in such offensive surgical condi- 
tions as foetid ozosna, otorrhoea, leucorrhosa, foul and sloughing ulcers, 
cancerous or otherwise. The usual strength is 1 : 500 or 1 : 1000, but 
much stronger solutions may be used. 

ACIDUM SULPHUROSUM (SULPHUROUS ACID). 

For what is it employed ? 

This is, of all disinfectants, the most commonly employed for the dis- 
infection of rooms. It acts as a deoxidizing agent, breaking up organic 
compounds, and becoming sulphuric acid in the process ; but probably 
its efficiency is due to a direct but not powerful germicidal effect, and it 
is said not to affect spores. The usual method of employment is to 
burn sulphur in a tightly-closed room, allowing from 20 to 30 ounces to 
every 1000 cubic feet of space, with proper precautions against fire. The 
officinal acid is a liquid containing 3J per cent, of the gas. 

HYDRARGYRI CHLORIDUM CORROSIVUM. 

What of its power as a germicide ? 

This salt, mercuric chloride or corrosive sublimate, is so much used in 
surgical procedures as to warrant detailed notice. As a germicide it is 
particularly powerful, solutions of 1 : 20,000 quickly destroying micrococci 
and bacilli, while 1 : 2000 will destroy the most resistant spores. It is 
decomposed by ammonia — a fact which lessens its value as a disinfectant 
— but it still remains one of the best measures for this purpose. It is 



192 ANTISEPTICS, DISINFECTANTS, GERMICIDES. 

much used (1 : 1000) for disinfecting bedding, etc., and in stronger solu- 
tions for destroying the germs in alvine discharges. It is indispensable 
as an antiseptic in surgical operations for disinfecting the field of opera- 
tion, hands, sponges, dressings, etc., but corrodes instruments, which 
should be kept in solutions of carbolic acid or in sterilized water. 

Notice has been already taken of the antiseptic properties of carbolic 
and salicylic acids, iodoform, iodol, thymol, creolin, etc. 

ACIDUM BORICUM (BORIC ACID). 

What are its properties, effects, and uses ? 

Boric (or boracic) acid occurs in transparent, white, hexagonal plates, 
of oily feel, permanent, and soluble with a slightly acid reaction in 25 
parts of water, more so in glycerin and alcohol. It is a good antiseptic, 
but possesses only weak germicidal effects. Internally, it acidifies the 
urine. It forms a very useful antiseptic wash in some conditions of the 
mucous membranes, as cystitis, conjunctivitis, sordes, etc.,, producing an- 
tiseptic results with very slight irritation. > Absorbed or taken in large 
amounts, it is said to produce gastro-enteritis, but such effects must be 
rare. 
What is " Thiersch's solution " ? 

A combination much used in the surgery of mucous membranes, as the 
bladder, oral and nasal cavities, etc., is that of Thiersch, or "boro- 
salicylic," which contains of salicylic acid 2 and boric acid 12 parts, in 
water to 1000 parts. 

SODII BORAS (BORAX). 

How does borax differ from boracic acid ? 

This salt differs from the acid principally in being efflorescent, and in 
forming alkaline solutions with water, in which it is soluble, 1 : 16. It is 
insoluble in alcohol and freely soluble in glycerin. Its alkaline reaction 
gives it antacid properties, and as a combined antacid and antiseptic it 
finds its chief value in aphthous, diphtheritic, and other inflammations 
of the mouth and throat. Claims of utility in epilepsy have been made 
for it. 

AQUA CHLORI (CHLORINE- WATER). 

What are its manufacture and properties ? 

This preparation, in which form alone chlorine is officinal, is made by 
the reaction of manganese binoxide and HC1. It is a clear, greenish- 
yellow liquid, containing 0.4 per cent, or more of CI, and having the 
unpleasant odor and taste of that element. 

What are its effects and uses ? 

Chlorine gas acts as an indirect oxidizing agent, uniting with the hydro- 



CALX CHIiORATA, 193 

gen of organic matter and liberating <).,. which rapidly destroys th< 
ganic compound. It is a powerful germicide^ an Injurs exposure to a 
moist atmosphere containing I per cent, of the gas being sufficient to 

destroy all spores: but it is a decided respiratory irritant, and BOmewhat 
destructive to textile fabrics, especially it' colored. Chlorine-water has 

been used internally in doses of 3SS to oil'- well diluted, as an intestinal 
disinfectant, but probably is of no value. In proper dilution it is a good 
disinfectant and stimulant wash for foul ulcer*, and as a gargle in scarlet 

f r, ,■ and sore throat. Thlorine gas is generally used in the form of 

CALX OHLORATA (CHLORINATED LIME . 

rhlorinated lime, or bleaching powder, is a compound of varying chem- 
ical nature resulting from the action of chlorine on calcium hydrate, and 
containing at least 25 per cut. of available CI gas^ which can be slowly 
set free by C0 2 , more rapidly by the addition of an acid. It occurs in 
a white, dry powder of chlorinous odor and a disagreeable saline taste, 
gradually becoming moist and decomposing in the atmosphere. 

What are its effects and uses ? 

It acts only locally, and may be used in the same conditions as chlorine- 
water. For the disinfection of rooms the room should be tightly closed. 
an acid added to hasten the evolution of the gas, and left for many hours. 
For the disinfection of rooms it is inferior to sulphur, but for that of 
excreta and infected filth generally a saturated solution is the most 
efficient known. 

What is " Labarraque's solution " ? 

Liquor sodse chlorinate, or Labarraque's solution, contains 2 percent, 
of available chlorine. Upon this its effects and uses depend, and they 
correspond to those of calx chlorata. Its advantages lie in its liquid 
form and its comparative freedom from odor, so that it is a more elegant 
form for use. 

AROMATICS. 

What are their active principles and uses ? 

Drugs of this class owe their efficacy to oils obtained from them by 
distillation, and termed volatile, distilled, or essential oils. These oils are 
volatile, inflammable, soluble in alcohol and ether, and themselves dis- 
solve fixed oils. Locally, they are used as (1) counter-irritants, (2) !>><'< d 
anassthetics, and (3) antiseptics; internally, as (4) antispasmodics or car- 
minatives by stimulating the intestine and thus expelling flatus ; as (5) 
digestive aids, (6) diffusible stimulants, and (7) to disguise the taste of 
unpleasant drugs. Following is a brief description of some of the most 
important ones, few of which require detailed notice: 

Cinnamomum (bark of Oinnamomum Zeulanicum^ a native of 
Ceylon) contains oleum cinnamomi (U. S.) and tannic acid. The oil 
13— M. M. 



194 AROMATICS. 

is much used to disguise the taste of unpleasant medicines. Aqua 
cinnamomi (2 per cent. ) is also used as a vehicle. For the aromatic and 
astringent effects of the drug the tincture (3j-ij) and spirit (tt\,x-xxx) 
may be employed. 

Caryopnyllus (cloves). — Caryophyllus is the unexpanded flowers of 
Eugenia caryophyllata, a small East Indian tree. Oleum caryophylli, 
to which it owes its efficiency, is officinal ; dose n\j-vj. It fulfils the 
general indications for aromatics mentioned above, and is much employed 
as a local anaesthetic in toothache. It is an efficient carminative and 
much-used spice. 

Myristica (nutmeg), the kernel of the fruit of M. fragrans, a tropical 
tree, contains a fixed and volatile oil, the latter officinal — oleum myristicae. 
Large doses produce narcotic effects. Although employed chiefly as a 
condiment, it is an agreeable flavoring agent, and is used to prevent the 
griping of cathartics and in diarrhoea. Besides the oil, the dose of which 
is ^ij-v, spiritus myristicae is officinal in 3j doses. 

Macis (mace), another portion of the same fruit, contains the same 
volatile oil and fulfils the same indications. 

Pimenta (allspice), unripe berries of Eugenia pimenta, contains a 
volatile oil {oleum pimentae, U. S.), the dose of which is gtt. ij-v. 
Habitat, South America. 

Oardamomum (cardamom), fruit of Elettaria cardamonium of 
the East Indies, contains a volatile oil, fixed oil, starch, etc. It is very 
agreeable to the taste, and much employed as a carminative and to con- 
ceal the taste of unpleasant medicines. Tinct. cardamom, comp. is an 
elegant vehicle for castor oil and other drugs. 

Zingiber (ginger), the dried root-stock of Z. officinale of the East 
and West Indies, in its various preparations, officinal and proprietary, 
is a domestic remedy for colic, and is used as a stomachic in dyspepsia, 
especially when accompanied by flatulence. Its preparations are — 

Oleoresina Zingiberis, dose ^Iss-ij. 

Extractum Zingiberis Fluidum, dose tf\,x-xxx. 

Syrupus Zingiberis, dose 3j-ij. 

Tinctura Zingiberis, dose 3ss-j. 

Piper. — Black pepper is the dried unripe bei*ry of Piper nigrum, con- 
taining a volatile oil, an acrid resin, and an alkaloid (piperine) which 
was once supposed to possess antiperiodic properties. Its effects are 
those of a carminative stimulant 

Its preparations are — 

Oleoresina Piperis, ^li-j (in pill). 

Piperina, dose gr. j-v. 

Capsicum, already mentioned under Irritants, has a distinct value 
in feeble digestion, and especially that of drunkenness. It is said to be 
of value locally in acute tonsillitis and scarlatinal sore throat, either the 
diluted tincture as a gargle or pure applied with a swab. 

Other frequently-employed flavoring vehicles are Oleum Sassafras, 
Aurantii Amari Cortex, and Aurantii Dulcis Cortex. 



DIETETICS. — ANIMAL FOODS. 195 

DIETETICS. 

What are the uses of foods, and what their therapeutic import- 
ance ? 

Naturally, but a brief resume of this extensive subject can be attempted 
in a treatise of this kind. The importance of foods as remedial agents 
in various forms of disease cannot be overestimated, for on them mainly 
we rely to repair tissue- waste, while the regulation of the diet in certain 
diseases, notably acute febrile conditions, gastric disorders, and nephritis, 
is all important, The ultimate uses of food, then, are to repair tissues, 
and to supply energy, which is manifested in muscular, secretory, and 
nervous activity, etc. 

How may food-stuffs be classified ? 

The various aliments may be classified under the following groups: 
I. Mineral substances, which enter into the composition of tissue, are 
incapable of further oxidation, but perform certain necessary functions 
in the human economy — i. e. water, calcium phosphate, sodium chloride, 
etc. ; II. Substances capable of further oxidation, with the production of 
heat and energy, or of being stored up as tissue, which secondarily under- 
goes oxidation with the same effects. This forms the most important 
group, and includes proteids, fats, carbohydrates (sugar, starch, etc.); 
III. Food adjuncts, including tea, coffee, alcohol, etc. A convenient 
classification of foods for purposes of consideration is into animal and 
vegetable foods. 

ANIMAL FOODS. 

What is the composition and food- value of milk ? 

A perfect food, then, must contain proteids, fats, carbohydrates, salts, 
and icater. The nearest approach to this we find in milk, a good speci- 
men of which contains all these requisites and is an ideal food. An 
analysis of milk shows proteids (casein and albumin), fats (cream) car- 
bohydrates (lactose or sugar of milk), salts (chlorides, sulphates, and 
phosphates), and water. 

What substitutes may be employed for mother's milk ? 

In infant feeding, when for any reason the breast-milk is not available, 
the following substitutes may be employed : (1) Good fresh coids milk 
properly prepared. Woman's milk differs from that of the cow in con- 
taining larger amounts of sugar and of albumin, but a smaller amount 
of casein, which coagulates in smaller flocculi. This casein in cow's milk 
coagulates into a denser mass, it being intended for further mastication 
by the young ruminant, To make cow's milk as nearly as possible re- 
semble the infant's natural food, it should be diluted with water, lime- 
water, barley-water, etc. The proportion of diluent should be greater 
the younger the infant ; thus, under six weeks of age nearly one-half 
should be added, from six weeks to two months one-third, and after that 



196 DIETETICS. 

age one-quarter. Lactose (Sij to Oj) and cream should then be added 
to make good the deficiency of these ingredients. In this way the casein 
coagulation is affected by dilution. (2) It may also be affected and its 
digestion assisted by peptonized milk powders. *(3) Condensed milk of 
good brands constitutes another very valuable means of infant feeding, 
especially in cities, where obtaining wholesome cow's milk is wellnigh 
impossible. This consists generally of a thick, viscid, semisolid mass, 
obtained by evaporating milk at a gentle heat and adding sugar to pre- 
serve it. Its indefinite strength is a disadvantage, rendering its proper 
dilution rather problematic, but most infants do well under its use. (4) 
Sterilized milk is also of great value in bottle-feeding during the summer 
months, and is a prophylactic and curative agent in diarrhoeal disorders. 

What are unwholesome modifications of milk? 

Milk obtained from cows during the first two or three weeks of lacta- 
tion contains more or less colostrum, which gives it an unpleasant odor 
and taste and some purgative properties, and renders it unsuitable for 
feeding children. Milk from cows during advanced pregnancy, during 
and for some days after u heat," or when suffering from inflammation of 
the udder, is unwholesome. Poisonous pasturage may affect milk. 
Cows suffering from tuberculosis, anthrax, foot-and-mouth disease, etc. 
should not be utilized for milking purposes : tuberculosis and anthrax 
have without doubt been thus communicated to man. 

What other diseases may be caused or conveyed by milk? 

Scarlet fever and diphtheria have been conclusively proven to have been 
thus transmitted ; at least in the case of the former a very similar 
disease exists in the young animal. Typhoid fever has at times been 
traced to milk. Tyrotoxicon-poisoning. — As the result of certain putre- 
factive changes, due here as elsewhere to micro-organisms, a poisonous 
principle called " tyro toxicon''^ is developed; milk or milk products, as 
ice cream, cheese, etc., containing this poison give rise to the symptoms 
of irritant poisoning — viz. nausea, violent vomiting, burning pain in the 
throat, oesophagus, and stomach, diarrhoea, and profound depression, 
lasting for a few hours and generally ending in recovery. While the 
symptoms are very distressing and severe, the autopsies in fatal cases 
have been almost negative, the lesions of gastro-enteritis being almost 
entirely absent. From this it has been inferred that the poison exerts a 
purely centric effect. 

In what conditions is a milk diet indicated ? 

Full milk diet consists of from 4 to 6 pints of milk daily. Many 
patients will not be able, however, to consume even the smaller of these 
amounts, the fats being in greater quantity than they can assimilate. 
The customary method of administration is to give a glassful (§vj-viij) 
every two hours. Some patients have an idiosyncrasy and really cannot 
take it. Many more will say they cannot, but after a thorough trial will 



ANIMAL FOODS, MILK. 197 

generally succeed. Lime-water. Vichy, common salt. etc. may make it 
more palatable and better borne. Its use is indicated in pulmonary 
tuberculosis and wasting diseases generally. The object of its administra- 
tion in these cases is to promote tissue-formation : the patient's digestion 
must be good, and no more should be taken than can readily be assim- 
ilated. In febrile conditions generally it forms an easily digested food. 
In chlorosis and the severer anosmias forced feeding with plenty of milk 
is a valuable adjuvant to drugs. In albuminuria an exclusive milk diet 
will generally greatly ameliorate the symptoms, and may cause the entire 
disappearance of albumin from the urine. In gastric ulcer, toxic gastri- 
tis, and typhoid fever it is the only permissible food, while in carcinoma 
of the stomach, dyspepsia, and severe gastralgia it may give relief. In 
diarrhoeas, dysentery, and chronic intestinal indigestion it leaves no indi- 
gestible residue to ferment and irritate, and often proves efficacious. 

What are the unpleasant effects of prolonged milk diet ? 

The continued use of milk is apt to prove repugnant to the patient. 
It tends to constipate, the cases in which it produces diarrhoea being due 
to lack of assimilation and consequent fermentation and irritation. A 
decrease of bod\ T -weight often occurs, and the patient may experience 
disagreeable sensations of emptiness, dizziness, and weakness. In rare 
cases these symptoms may be so pronounced as to necessitate its discon- 
tinuance. 

DERIVATIVES OF MILK, AND THEIR PECULIAR 

PROPERTIES. 

CREAM. 

What does it represent ? 

This substance is obtained from milk by allowing it to rise or by cen- 
trifugal force. It is employed in making butter and cream cheeses. It 
represents most of the fat of the milk, of which constituent it contains 
from 25 to 33 per cent. 

SKIMMED MILK. 

Has it any food value ? 

Milk minus cream, or skimmed milk, still contains a fair amount of 
proteids and lactose, and hence has considerable value as food. 

BUTTER. 

How is it obtained ? What causes its rancidity ? 

By agitation, or ''churning," the fat of the cream is separated, and is 
known as butter. Butter presents fats in an easily digestible form, and 
contains of them about 85 per cent. Rancidity of this product is due to 
a fermentative process, resulting in the separation of the butyric and 



198 DIETETICS. 

other acids from their base, glycerin. It is hastened by the presence 
of too much casein or water from imperfect separation. 

Buttermilk, the resultant liquid in butter-making, is a nutritious 
food ; it contains casein, lactin, and salts. It is easily digestible, prob- 
ably in consequence of the lactic acid it contains, and may be substituted 
for milk in albuminuria, diabetes, and gastric disease, constituting the 
so-called buttermilk cure for these disorders. 

Cheese is made by coagulating the casein of milk by rennet and sub- 
sequent compression. The coagulating casein entangles the fats and 
some of the lactose and salts in its meshes, so that analyses of cheese 
show it to be a highly nutritious product. By the ' ' ripening process, ' ' 
which lasts from four to six weeks, volatile, odorous constituents are de- 
veloped, giving it its flavor. Although so highly nutritious, it is, in the 
main, hard to digest, and is not suitable for the sick. Whey, the liquid 
portion of the milk expressed during cheese-making, contains very little 
of nutritive value. 

KOUMYSS. 

How is it made ? What are its constituents and uses ? 

Koumyss is an effervescing alcoholic drink obtained by fermentation 
of milk. Mare's milk was originally used, and is preferable, but cow's 
milk is now employed in its manufacture, lactose being added to give 
more sugar for fermentation, and thus greater alcoholic strength. Be- 
sides alcohol, this milk-product contains carbonic acid and certain ethers. 
During fermentation the milk separates in layers, the uppermost being 
koumyss and the lowermost casein. In good koumyss not all the casein 
should be precipitated, and no sugar should be present, as it should all 
have been changed to alcohol. It contains 1 i to 4 per cent, of alcohol, and, 
roughly speaking, is one-third the strength of champagne. It should 
be kept tightly corked and in a cool place, and should be frequently 
shaken. 

Although its sour taste is disagreeable to some palates, it is surpris- 
ingly well borne by even the most delicate stomachs, and forms a valu- 
able stimulant and food in cases of malnutrition from any cause, espe- 
cially when accompanied by gastric disturbance. When first introduced 
it was claimed to be a specific in tuberculosis, but this claim is no longer 
made for it. 

MATZOON. 

What is matzoon ? what are its uses ? 

Matzoon is milk which has undergone lactic-acid and not alcoholic 
fermentation, yet differs from sour milk in that the process is checked 
when a certain degree has been reached. It is said to be well borne by 
irritable stomachs. 



ANIMAL FOODS.— MILK. — EGGS. 199 

PEPTONIZED MILK. 

What are its advantages? 

This artificial milk-product is of such undoubted value, and so indis- 
pensable in certain cases, that a somewhat detailed account of its prepara- 
tion and uses may be given. Milk, as we have seen, is a perfect food. 
Two of its components, lactose said fats, are easily digested, but with the 
albuminoid, casein, the case is different, and by its partial or complete 
conversion into peptones the digestion of milk may be greatly 
facilitated. 

What are the steps in peptonizing milk ? 

The steps in detail are as follows : The most convenient form in which 
to obtain the pancreatic principle is the various proprietary preparations 
of "extractum pancreaticum " or u pancreatin," which are dispensed 
in tubes mixed with varying proportions of sodium bicarbonate. 
Ordinarily, one of these tubes is sufficient for one pint of milk. To 
the contents of one tube add about §ij of water and stir thoroughly. 
Then add a pint of warm fresh milk, and keep the mixture at a tem- 
perature of 100° F. for thirty minutes, at the expiration of which time 
it is removed to a cool place — which checks the activity of the ferment — 
and kept until used. If the process be continued too long, certain 
products unpleasant to the taste, and perhaps poisonous, may develop. 
The bitter flavor should not be marked. By first removing the cream, 
then peptonizing, and then adding the cream again, a result more palat- 
able and more milky in appearance is said to be obtained. 

If suitable arrangements for regulating the temperature are not avail- 
able, milk may be peptonized at the ordinary temperature of the sick- 
room, as follows : To a pint of milk, mixed with i pint of water, add 1 J 
tubes of the extract ; then set aside for from four to five hours, and 
use immediately, or bring to a boiling-point to stop fermentation, and 
keep in a cool place. 

What are the therapeutic uses of peptonized milk ? 

In wasting diseases, especially when more or less complete anorexia 
obtains, in the persistent and intractable vomiting of chronic gastritis, 
uraemia, gastric congestion from cirrhosis, or chronic endarteritis, and 
after abdominal incision, it may often furnish relief; in gastric ulcer 
small amounts of this or other artificially digested fluids form the most 
rational and efficient treatment. 

EGGS. 

In what alimentary principles are eggs rich? 

The eggs of the ordinary domestic fowl form a highly nutritious article 
of diet, containing a large proportion of nitrogenous matter (14 per 
cent.) and a comparatively small amount of non-nitrogenous. In full 
diet, then, they should be combined with starchy and fatty food. The 



200 DIETETICS. 

fat of eggs is found entirely in the yelk, while the white of the egg is 
the more highly nitrogenous. In cooking, the albumin should be ren- 
dered simply opaque, as hard-boiled eggs are indigestible and cause con- 
stipation. To invalids uncooked eggs are given with milk and alcohol. 

BEEF. 

What are its chief constituents ? 

Roughly speaking, good beef contains about 20 per cent, of nitrog- 
enous and 20 per cent, of fatty matter, with salts, extractives, etc. The 
nitrogenous elements are partly in solution (as myosin, the cause" of rigor 
mortis) and partly solid. From its composition it is seen that beef con- 
tains nutritive principles of prime importance to the sustenance of the 
body. 

Describe the changes of rigor mortis. 

The normal alkalinity of the body fluids changes to acidity and the 
myosin is coagulated. Meat ordinarily should not be eaten until this 
subsides. 

VEAL. 

What about its digestibility? 

Veal has the reputation of being more slowly digested than beef— an 
opinion due probably to the fact that it is more difficult to thoroughly 
masticate. It sometimes exerts a laxative effect, and is seldom used by 
invalids. It contains, roughly, 17 per cent, of nitrogenous and 16 per 
cent, of fatty substances. 

MUTTON. 

Although possessed of a lower nutritive value than beef, mutton is 
easily digested and forms a valuable article of diet for occasional use. 
Continued use leads to a repugnance to it, and in some an apparent 
idiosyncrasy exists against it. It contains a large amount of fat (about 
40 per cent.) and between 9 and 10 per cent, of nitrogenous substances. 

PORK. 

Of all meats in common use, this is the hardest to digest, requiring 
between five and six hours for complete digestion. It is the fattest of 
meats, containing about 65 per cent, of fat and 8 per cent, of nitrogenous 
elements. With two exceptions it is not used for invalids, as it is not 
well borne by the stomach. Bacon, however, is well tolerated by many 
weak stomachs, and roast pig may at times be taken with advantage 
during convalescence. If tolerated by the stomach, pork is suitable for 
phthisical patients. 

CHICKEN. 
The flesh of the ordinary domestic fowl, combining as it does ease of 



ANIMAL AND VEGETABLE FOODS. 201 

mastication and digestion with an agreeable flavor, is a valuable and 
much-used article of diet for the sick. Other domestic and wild fowl 
may often be of value. 

What animal viscera are sometimes used for food ? 

Sweetbread, properly the thymus of the calf, but more often the pan- 
creas, is an agreeable, nutritious, and easily digested food. Tripe, the 
stomach of the ox and other ruminants, combines the same qualities. 
The brain is also easily digested, and contains fats and phosphorus. 
Liver, although nutritious, is too hard of digestion for the sick. Kidneys 
are objectionable for both sick and well. 

What fish are suitable for invalids? 

Certain varieties offish, as whitefish, bass, trout, etc., are suitable 
articles of diet for the sick. As a rule, they are easily digestible if 
boiled, in which way alone they should be served to invalids. Of shell- 
fish, oysters are especially valuable. They are more easily digested when 
served uncooked, because the brown part of the oyster, the liver, is com- 
posed of glycogen and a ferment, diastase, the later of which, if not 
destroyed by heat, aids in digesting the former. 

VEGETABLES. 

What can you say of wheat ? 

Among the cereals wheat is the most important. Wheat bread, prop- 
erly made, is easily digestible, nutritious, and nearly all assimilated, leav- 
ing very little residue. This fact accounts for its tendency to produce 
constipation. Bread made from unbolted flour is more nutritious, less 
apt to produce constipation, and, being less permeable to the digestive 
fluids, is less easily digested. Fresh bread is difficult to masticate 
thoroughly, and should not be served to invalids. 

What of cracked wheat and its effects ? Oatmeal ? Cornmeal ? 

Cracked wheat, which is boiled until the envelope is burst, is eaten 
with cream and sugar, forming a pleasant, highly nutritious, and some- 
what laxative food. Oatmeal and cornmeal are staple articles of food, 
and, prepared in various ways, are acceptable to the sick. Like the 
above, they are apt to produce a somewhat laxative effect. 

What food-stuffs are largely farinaceous ? 

Starch, sago, tapioca, and arrow-root are quickly digested, and are 
largely used for the sick. They contain no nitrogen, and hence are not 
capable of maintaining life for any considerable time. 

What of the composition and food-value of the potato ? 

Next to wheat, the ordinary potato is the most used vegetable in gen- 
eral diet. It contains a large amount of starch (about 16 per cent. ) and 
small percentages of sugar and nitrogenous matters. Boiled to a dry and 
mealy condition, it may be used by the sick, but in no other condition is 



202 DIETETICS. 

it suitable for this purpose. The sweet potato differs chiefly in the larger 
proportion of sugar it contains, and is probably less easily digested. 
Other vegetables in common use are seldom used for sick diet. 

SPECIAL PLANS OF DIET. 

For what uses is low diet employed ? 

In obesity. For the reducing of superfluous fat it is necessary to 
largely interdict the saccharine, fatty, and starchy elements of food: of 
these, sugar is the most fat-forming, and should be very sparingly used. 
Various treatments of this sort have received the name of Bantingism. 

In aneurism. By a combination of perfect rest in the recumbent posi- 
tion and extremely low diet, largely dry, a good effect may be produced 
upon internal aneurism. 

What are the indications for dry diet? 

A diet in which the amount of fluid ingested is limited may be of 
signal service in dropsical conditions, hydrothorax, ascites, etc. A satis- 
factory plan is to so limit the amount of fluids that the watery excreta 
are in excess of those ingested. 

What are the indications for animal diet? 

The chief indication for a more or less exclusive meat diet is found in 
diabetes. Most vegetables contain sugar or starch, which easily under- 
goes conversion into sugar, and they should be interdicted. Tomatoes, 
celery, and raw cabbage are about the only vegetables consistent with a 
strict diabetic diet. Gluten bread relieves to a degree the longing for 
wheat bread, which is ordinarily the greatest deprivation. Fats generally 
must be used freely. By a strictly meat diet nearly or quite all of the 
glucose may be made to disappear from the urine. 

Meat diet also proves of value in diarrhoea, whether acute or cJironic, 
and is indispensable in cachectic conditions generally. 

What food is suitable for acute febrile conditions? 

During acute inflammatory and febrile conditions all the organs of the 
body are subject to a degenerative process, and all the functions are to a 
greater or less degree impaired. This tissue-destruction is evidenced by 
a large increase in those excretory elements which represent tissue, espe- 
cially urea, urates, phosphates, etc. On the other hand, the processes of 
constructive metamorphosis are incomplete. The digestion shares with 
others this lessened power. Hence the importance of administering 
such food as shall be most easily digested. As a general rule, in such 
conditions milk diet is indicated. Beef tea, which once enjoyed popu- 
larity for this purpose, is inferior in nutritive properties and more 
difficult of digestion. Digestibility, to be sure, may be enhanced by 
peptonizing (by a process similar to that given in detail under Milk), but 
this does not make good the inferior food value. 



DIETARIES.— DIGESTIVE FERMENTS. 203 

DISEASES OF THE ALIMENTARY TRACT. 
What should be the alimentation in acute gastritis ? 

In all conditions our guiding principle should be to give the affected 
organ as nearly complete physiological rest as possible. Thus in acute 
gastritis small amounts of milk, milk with lime-water, milk with Vichy 
or carbonic waters, milk with barley-water, and demulcent drinks should 
be given frequently. Effervescent drinks, as champagne in small quan- 
tities, are generally well borne. 

What should be the alimentation in chronic gastritis ? 

When for any reason there appears to be a deficiency of gastric juice, 
our aim should be to administer foods largely digested in the small intes- 
tine, such as starches, tapioca, arrow-root, rice, and the farinaceous veg- 
etables generally. On the other hand, when heartburn (acid fermenta- 
tion) occurs from fermentation of starchy and fatty foods, these articles 
should be taken sparingly. 

What should be the alimentation in intestinal indigestion ? 

Again, in cases of intestinal indigestion, summer diarrhcea, and other 
conditions dependent upon functional or inflammatory disorders of the 
small intestine, foods entirely or for the most part digestible in the stomach 
should be given. Starches and fats should be interdicted, and nitrogenous 
foods, as milk, eggs, meats, should be administered. 

What should be the alimentation in chronic constipation ? 

Here a suitable diet is of prime importance. Materials leaving a large 
amount of indigestible residue, as fresh vegetables, oatmeal, corn and 
brown bread, raisins, almonds, prunes, etc., may materially aid in over- 
coming this condition. 

What should be the diet in cachectic conditions ? 

The objects to be attained are an increase of the muscular and fatty 
tissues. As fat-forming elements, fats (in milk, cream, meats), sugar 
(in its own form or in sweet fruits), and abundant starches are indicated. 
Thus, a combination of nitrogenous and carbonaceous foods is to be 
given, and freely. In severe anaemic conditions, as pernicious anaemia, 
Addison's disease, etc., frequent (or "forced") feeding may prove 
advantageous. 

DIGESTIVE FERMENTS. 

In this connection we may consider briefly certain physiological fer- 
ments which have to do with the digestive process. 

PEPSINUM (PEPSIN). 
What can you say of pepsin, its properties, and its preparation ? 
Pepsin is the digestive ferment of the gastric juice, and is obtained by 



204 DIGESTIVE FERMENTS. 

different methods from the mucous membrane of the hog's stomach. It 
is somewhat soluble in water, and freely so in water slightly acidulated 
with hydrochloric acid. The purest and most reliable pepsin is obtained 
by dissolving it in hydrochloric acid, drying, and diluting to a fixed 
standard, when it is known as saccharated pepsin : " 1 part in an acid- 
ulated solution should dissolve 50 parts of egg-albumin in five or six 
hours at a temperature of 40° C." As first obtained, pepsin is a viscid 
fluid ; dried upon plates and without artificial dilution, it is known as 
"scale pepsin." Alcohol checks the activity of the ferment, so that 
preparations made with wine and alcohol are inferior. Glycerin solutions 
are potent and keep well. 

What are the uses of pepsin ? 

Naturally, the chief indication for its use is weakened digestive power. 
When hydrochloric acid is wanting or diminished in the gastric secretion, 
the addition of this element undoubtedly increases its value. Even at 
the standard strength indicated above (and few preparations approximate 
this) the doses habitually given could be of very little actual benefit 
unless a stimulant action upon the mucous membrane be supposed to 
take place ; and some authorities are skeptical as to its real value. Act- 
ing as a ferment, however, its activity may be increased by repeating the 
dose of hydrochloric acid. 

The diarrhoea of children, dependent upon imperfect gastric digestion, 
may be greatly benefited by pepsin. It has been suggested as a solvent 
for diphtheritic membranes and blood-clot in the bladder. 

PANCREATINE. 

Useful preparations of this important ferment exist both in the liquid 
and solid forms — liquor pancreaticus and extract of pancreatine. Given 
by mouth, it is probably rendered more or less inert by the gastric juice 
before it reaches an alkaline medium in which it can act. Its chief and 
great value is for the partial digestion of food before it is given. This 
artificial digestion of food has already been considered. (See Peptonized 
Milk.) 



TABLE OF DOSES 

OF KEMEDIES MOST FKEQUENTLY ADMINISTERED. 



For hypodermatic use the dose should be half that used by the mouth. 
For use by rectum the dose should be twice that used by the mouth. 
Doses for Children. — Dr. Young's rule: Add 12 to the age, and divide by the age to 
give the denominator of a fraction, the numerator of which is 1. 

12 + 2 
Example : For a child two years old, - — = \ ; the dose should be fth that for 

an adult. In giving powerful medicines and opium still smaller doses must be 
used for children. 



Kemedies. 



Abstracta. (See Extracta. Double the dose.) 

Acetanilid (antifebrin) 

Acid, arsenios 

benzoic 

boric 

carbolic 

gallic 

hydrobrom. dil. . ■ 

hydrocyan. dil 

hydrochlor. dil 

nitric, dil 

nitro-hydrochlor. dil 

phosphoric, dil 

salicylic. . . 

sulphuric, dil 

sulphuric, arom 

sulphuros 

tannic 

Aconitina (white crystals) 

Adonidin 

Agaricin 

Aloe 

Aloinum 

Ammoniibenzoas 

bromid 

carb 

chlorid 

iodid., ) 

valer., j ' ' 

Amyl nitris (inhaled or internally) . . . 

Amylene hydrate (hypnotic) 

Antimon. et pot. tart. ; diaph 

et pot. tart. ; emetic 

Antipyrin 

Apiol 

Apomorph. hydrochlor 

Arbutin 



Grains or 


Grams or Cubic 


Minims. 


Centimeters. 


2—15 


0.1 — 1. 


itz — So~ 


0.001 — 0.003 


5-15 


0.3 — 1. 


5-10 


0.3 — 0.65 


h-U 


0.03 — 0.1 


3—15 


0.15 — 1. 


10—60 


0.65 — 4. 


2— 6 


0.1 — 0.35 


5—20 


0.3 — 1.3 


5—20 


0.3 — 1.3 


5-20 


0.3 — 1.3 


5—30 


0.3 — 2. 


5-20 


0.3 — 1.3 


5—30 


0.3 — 2. 


5-15 . 


0.3 — 1. 


30—60 


2. — 4. 


2—10 


0.1 — 0.65 


TJOTT SHO- 


0.0002— 0.0003 


TS h 


0.006 — 0.02 


i-i 


0.008 — 015 


2— 5 


0.13 — 0.3 


1-3 


0.008 — 0.18 


10—20 


0.65 — 1.3 


5—30 


0.3 — 2. 


3—10 


0.2 — 0.65 


10—30 


0.65 — 2. 


2-15 


0.1 — 1. 


2— 5 


0.1 — 0.35 


10-60 


0.6 — 4. 


5ff — To 


0.003 — 0.006 


1— 2 


0.06 — 0.13 


2—15 


0.1 — 1. 


5—10 


0.3 — 0.65 


i i 

30 TO 


0.003 — 0.006 


5-15 


0.3 — 1. 



205 



206 



TABLE OF DOSES. 



Kemedies. 



Argenti nitras 

Arsenii iodidum 

bromid 

Atropine sulphas 

Auri et sodii chlorid . . . 

Bismuthi subnitras 

Caffeina 

Calcii lacto-phosphas 

Calx sulphurata 

Camphora 

Camph.monobrom. . • 

Capsicum 

Cerii oxalas 

Chinoidinum 

Chloral 

Chloroformuni 

Chrysarobinum 

Cinchonidina, and its salts 

Cocaina (locally, 1 to 4 $ sol.), internally 

Codeina 

Colchicin 

Confectio sennse 

Coniina, and its salts 

Copaiba 

Creasotum 

Creolin (locally, \ to 2 $ sol.), internally . 

Croton chloral ! . 

Cubeba 

Cupri acetas 

sulphas 

Curare 

Digitalinum 

Digitalis 

Elaterinura ; U. S. P. 1880 

Ergota 

Ergotinum 

Eserina. and its salts 

Extractum aconiti [rad.] ; U. S. P. 1880 . 

aconiti [rad.], fluid. ; U. S. P. 1880 . . 

aloes aquos 

bellad. alcohol 

bellad. fl 

buchu fl 

calumbse fl 

cannab. ind. (with caution) 

cannab. ind. fl. (with caution) . . . 

cascar3esagrad.fi 

cimicifugBe fl 

colchici rad. fl., 

colchici sem. fl., 

colocynthidis comp. 

conii fl 

convallarise rad. fl. . 

digitalis 

digitalis fl 

ergotae 

ergotse fl 

erythroxyli fl. (coca) 

eucalyptf fl 

gelsemii fl 

gossypii fl 

grindeliae rob. fl. . . 

guaranse fl 



Grains or 


Grams or Cubic 


Minims. 


Centimeters. 


4- h 


0.01 — 0.03 


bV— tV 


0.001 — 0.006 


53 rV 


0.001 — 0.004 


i i 

T2"8" 32 


0.0005— 0.002 


1 1 

33 8 


0.002 — 0.008 


5— 60 


0.3 — 4. 


1— 5 


0.06 — 0.3 


5— 10 


0.3 — 0.65 


tV- 1 


0.006 — 0.06 


3— 10 


0.2 — 0.65 


2— 5 


0.1 — 0.3 


1— 5 


0.6 — 0.3 


1— 10 


0.06 — 0.6 


3— 30 


0.2 — 2. 


3— 20 


0.2 — 1.3 


1— 30 


0.06 — 2. 


tr- 3 


0.01 — 0.2 


5— 30 


0.3 — 2. 


rV- h 


0.004 — 0.03 


tV- ^ 


0.004 — 0.13 


TU<5 5(7 


0.0006— 0.0013 


60—120 


4. — 8. 


TUU 6 


0.0006— 0.01 


15— 60 


1. — 4. 


h~ 5 


0.03 — 0.3 


i— 5 


0.03 — 0.3 


1— 5 


0.06 — 0.3 


2— 60 


0.12 — 4. 


4- i 


0.008 — 0.03 


tV" i 


0.004 — 0.015 


33 TU 


0.002 — 0.006 


Wi 35 


0.001 — 0.002 


4- 2 


0.008 — 0.13 


&-:& 


0.001 — 0.005 


15— 60 


1. — 4. 


2— 8 


0.13 — 0.5 


Bl 2V 


0.001 — 0.003 


1 1 

T2" ¥ 


0.005 — 0.015 


2— 1 


0.03 — 0.06 


^— 10 


0.03 — 0.65 


h— h 


0.01 — 0.03 


1— 3 


0.06 — 0.02 


30— 60 


2. — 4. 


15— 30 


1. — 2. 


t 1 — \ 


0.004 — 0.03 


h~ 1 


0.03 — 0.06 - 


10— 30 


0.6 — 2. 


5— 30 


0.3 — 2. 


2— 8 


0.12 — 0.5 


5— 15 


0.3 — 1. 


1— 10 


0.06 — 0.6 


5— 30 


0.3 — 2. 


h~ 1 


0.008 — 0.06 


1— 6 


0.06 — 0.4 


i— 15 


0.03 — 1. 


15— 60 


1. — 4. 


15—120 


1. — 8. 


5— 30 


0.03 — 2. 


2— 5 


0.13 — 0.3 


15— 60 


1. — 4. 


10— 60 


0.6 — 4. 


30—120 


2. -4, 



TABLE OF DOSES. 



207 



Remedies. 



Grains or 
Minims. 



Extractum haematoxyli 

hydrastis fl 

hyoscyami alcohol, 
hyoscyami fl. . . . 

ignatiae 

iridis fl 

leptandrse fl. ... 

lobeliae fl 

matico fl 



nucis vomicae . 
nucis vomicae fl. 



opu 

physostigmse 

pilocarpi fl v 

podophylli 

prun. virg. fl 

pulsatillae fl 

quebracho fl. (aspidosperma) . 

rhei fl 

scillae fl 

scoparii fl 

Scutellariae fl 

senegae fl 

sennae fl 

serpent, fl 

spigeliae fl 

stillingiaefl 

stramonii 

taraxaci 

ustilag. maid, fl 

uvae ursi fl . . . 

valer. fl 

veratr. vir. fl 

viburni 

xanthoxyli fl 

Fel bovis purif. 

Ferri arsen 

bromid 

carb. sacch 

et ammon. citr 

et ammon. tartr 

et pot. tart 

et strychn. citr 

hypophosphis 

iodidum sacch 

lactas 

oxid. hydrat. cum. magnes. ) 
(antidote to arsenic), ]' ' ' 

pyrophosphas 

subcarb. . 

sulphas 

sulphas exsiccat 

valer 

Ferrum dialys 

reduct 

Gaultheria, oil of 

Guarana 

Homatropinse hydrobrom. (mydriatic, 

locally, 0.2 $ to 4 f ), internally, 

Hydrarg. chlor. corros 

chlor. mite 

iodid. rubr 

iodid. vir 



10— 30 
10—120 



2— 

4- 

5— 

20— 

1— 



30— 60 



1 

i— 


i 

5 


i 


1 


16 

5— 


30 


\~ 3 
30— 60 


2— 


5 


20— 60 


5— 


30 


2— 


3 


15— 60 


15— 


60 


1— 


5 


60—240 


20— 30 


10— 60 


15— 45 


i 

5— 


h 

60 


15— 60 


30— 60 


30— 60 


2— 


8 


15— 60 


15— 60 


c 


10 


50 


6 



1— 

2— 

5— 
5— 



10— 30 



5 

10 

5 

3 



1— 

5— 

2— 

1— 

fSi-fS.l 

frequently 
1— 5 
5— 30 
1— 3 

i- 

1— 
1— 
1— 

3— 

8— 



3 
15 

5 
15 

30 



i oi 

1 1 

64 TO 

A- io 
i i 

50 To 

k- 1 



Grams or Cubic 
Centimeters. 



0.6 

0.6 

0.03 

0.1 

0.008 

0.3 

1.3 

0.06 

2. 

0.008 

0.06 

0.008 

0.004 

0.3 

0.03 

2. 

0.1 

1.3 

0.3 

0.1 

1. 

1. 

0.06 

4. 

1,3 

0.6 

1. 

0.015 

0.3 

1. 

2. 

2. 

0.1 

1. 

1. 

0.3 

0.003 

0.06 

0.1 

0.3 

0.3 

0.6 

0.06 

0.3 

0.13 

0.06 

16. 

0.06 
0.3 

0.06 

0.03 

0.06 

0.06 

0.06 

0.2 

0.5 • 



— 2. 

— 2. 

— 0.13 

— 0.5 

— 0.03 

— 0.65 

— 2. 

— 0.3 

— 4. 

— 0.03 

— 0.3 

— 0.06 

— 0.01 

— 2. 

— 0.2 

— 4. 

— 0.3 

— 4. 

— 2. 

— 0.2 

— 4. 

— 4. 

— 0.3 
—16. 

— 2. 

— 1. 

— 3. 

— 0.03 

— 4. 

— 4. 

— 4. 

— 4. 

— 0.5 

— 4. 

— 4. 

— 0.65 

— 0.01 

— 0.3 

— 1. 

— 0.65 

— 1. 

— 2. 

— 3. 

— 0.65 

— 0.33 

— 0.2 

-32. 

— 0.3 

— 2. 

— 0.2 

— 0.15 

— 0.2 

— 1. 

— 0.3 

— 0.65 

— 2. 

— 0.15 



0.01 — 

0.001 — 0.006 
0.004 — 0.65 
0.0013— 0.006 
0.01 — 0.06 



208 



TABLE OF DOSES. 



Remedies. 



Hydrarg. subsulphas flav •. 

as emetic 

c. creta 

Hydrastin 

Hydrogeni peroxid. (10 vol. sol.), locally ~) 
(25 to 100 c /o), pus destroyer ; tonic- > 
stimulant and antiseptic, per os, J 

Hyoscinse hydrobrom 

Hyoscyaminse sulph 

Hypnone 



Grains or 
Minims. 



Commencing'] 
doses to be ! 
increased 
cautiously. J 



Ichthyol (locally, 10 to 50 %), internally 

Infusum digitalis 

Iodoformum 

Iodol 

Iodum 

ipecacuanha {^ e e t ct -; ;;;;;;;; 

Jalapa 

Liq. aramon. acet 

acidi arseniosi, 

arsenii bromidi, 

arsen. et hydr. iod 

potassii arsenit., • 

sodii arseniatis, 

ferri chloridi . . 

ferri dialys 

potassii citrat 

Lithii benzoas 

bromid 

carb 

citras 

salicylas 

Lupulinum 

Magnesii carb 

citr. gran 

sulphis 

Mangani oxid. nigr. 

Massa copaibse 

ferri carb 

hydrarg 

Mist, asafcetidse 

chloroform! 

ferri et amm. acet 

glycyrrhizse comp 

magnes. et asafoet 

potassii citr 

rhei et sodse 

Morphina, and its salts 

Morrhuol (derivative of cod-liver oil) 

Moschus 

Naphthol 

Narceina 



\- \ 

2— 5 

3— 8 
3— 5 

30—120 



200 7TJ 

5U0 60 

5— 10 
3— 5 

m— f34 



15— 30 

15— 30 

f5 2— f58 



Grams or Cubic 
Centimeters. 



0.015 — 0.03 

0.12 — 0.3 

0.2 — 0.5 

0.2 — 0.3 

2. — 8. 

0.0003— 0.0009 



0.0003— 0.001 


0.3 


— 0.65 


0.2 


— 0.3 


4. 


—16. 


0.06 


— 0.3 


0.01 


— 0.03 


0.006 


— 0.015 


0.01 


— 0.06 


1. 


— 2. 


1. 


— 2. 


8. 


—32. 



0.06 



1. 



Nitro-glycerinum (1 % sol.) . 

Oleoresina aspidii (filix mas) 

capsici 

cubebse 

lupulini 

Oleum copaibre 

erigerontis 

eucalypti 

phosphoratum 

terebinthinse 



2— 10 


0.15 


— 0.65 


10— 30 


0.65 


— 2. 


f3 2— f34 


8. 


—16. 


5— 20 


0.3 


— 1.3 


5— 20 


0.3 


— 1.3 


2— 10 


0.13 


— 0.65 


5— 20 


0.3 


— 1.3 


5— 30 


0.3 


— 1.3 


5— 30 


0.3 


2. 


15— 60 


1. 


— 4. 


3 2—3 8 


8. 


—32. 


10— 30 


0.6 


— 2. 


1— 5 


0.06 


— 0.3 


5— 30 


0.3 


— 2. 


5— 15 


0.3 


— 1. 


1— 15 


10.06 


— 1. 


f5 4— f58 


6. 


—32. 


f51— f58 


4. 


—32. 


f51— f34 


4. 


—32. 


f31— f34 


4. 


—32. 


f 3 1— f 3 4 


4. 


—32. 


n\— fS2 


16. 


—64. 


n\—n\ 


16. 


—32. 




0.004 


— 0.03 


3— 60 , 


0.15 


— 4. 


2— 15 


0.1 


— 1. 


2— 5" 


0.15 


— 0.3 


e— I 


0.01 


— 0.3 


gtt. 1 in- \ 
creased, j 


0.03 increased 


15— 60 


1.0 


— 4.0 


e— h 


0.01 


— 0.03 


5— 20 


0.3 


— 1.3 


2— 5 


0.13 


— 0.3 


8— 15 


0.5 


— 1. 


5— 15 


0.3 


— 1. 


5— 10 


0.3 


— 0.6 


1- 3 


0.06 


— 0.2 


2— 30 ! 


0.12 


— 2. 



TABLE OF DOSES. 



209 



Remedies. 



Grams or 
Minims. 




Oleum tiglii gtt. \— 2 



Opium (14 % morphine) 

Paraldehyde 

Pelletierine (Tanret's) 

Phenacetin 

Phosphorus 

Physostigminse sulphas 

Picrotoxinum 

Pilocarpina, and salts 

Plumbi acetas 

Potassii acetas 

bicarbonas ... 

bitartras 

bromidum 

chloras 

cyanidum 

iodidum 

nitras 

tartras 

Pulv. antimonialis 

Pulv. glycyrrhizse comp 

ipecac, et opii 

jalapse comp 

morphinse comp 

rhei comp 

Resina copaibee 

euonymi 

guaiaci 

jalapse 

podophylli 

scammonii 

Resorcin 

Rheum 

Saccharin (substitute for sugar) .... 

Salicinum 

Salol 

Santonica . 

Santoninum 

Senna 

Sodii arsenias 

benzoas 

boras (in epilepsy) 

bromidum 

chloras 

hyposulphis 

iodidum 

phosphas 

salicylas 

sulphas 

Sparteine stdph. (cardiant and diuretic) 
Spiritus eetheris nitrosi 

aether, comp 

ammonise arom 

camphors 

Spiritus chloroformi 

Strychnina, and salts 

Sufphonal (best in hot mint-water) . . 

Sulphur 

Syr. ferri bromidi 

ferri iodidi 

scillse 

scillse comp 

senega 



T20 

A" 

1_ 

15— 60 
8— 60 

1— 2 
8— 60 
8— 30 

A- 4 

2— 30 
2— 15 

5 1—5 8 

1— 3 
30— 60 

5 — 15 

10— 60 

5— 15 

5— 60 

2— 10 
2— 5 
5— 20 
2— 5 

A- \ 

2— 10 
2— 5 
2— 30 
h~ 5 

5— 30 
2— 10 

6- 60 
b~ 5 
8—180 
i i 

64 10 

5— 15 

5— 30 

5— 30 

2— 5 

5— 20 

2— 30 

2—120 

5— 30 

60—120 

t 1 — 4 

15—120 

15—120 

15— 60 

5— 30 

15— 60 

64 — A 

5— 20 

5J-5 4 

5— 60 

5— 30 

30— 60 

5— 30 

f51— f5 2 



Grams or Cubic 
Centimeters. 



0.01 - 

0.008 - 

1.3 - 
15. 

0.1 - 
0.0005- 
0.0005- 
0.0005- 

0.001 - 

0.03 - 
1. 

0.5 - 

0.06 - 

0.5 - 

0.5 - 

0.003 - 

0.13 - 

0.13 - 
4. 

0.06 - 
2. 

0.3 - 

0.6 - 

0.3 - 

0.3 - 

0.13 - 

0.13 - 

0.3 - 

0.13 - 

0.005 - 

0.13 - 

0.1 - 

0.13 - 

0.03 - 

0.3 - 

0.15 - 

0.5 - 

0.015 - 

0.05 - 

0.001 - 

0.3 - 

0.3 - 

0.3 - 

0.13 - 

0.3 - 

0.13 - 

0.13 - 

0.3 - 
4. 

0.004 - 
1. 
1. 
1. 

0.3 - 
1. 

0.001 - 

0.3 - 
2. 

0.03 - 

0.03 - 
2. 

0.03 - 
4. 



- 0.06 

- 0.12 

- 4. 
-32. 

- 0.4 

- 0.0013 

- 0.0011 

- 0.0011 

- 0.03 

- 0.2 

- 4. 

- 4. 

- 0.13 

- 4. 

- 2. 

- 0.008 

- 2. 

- 1. 
-32. 

- 2. 

- 4. 

- 1. 

- 4. 

- 1. 

- 4. 

- 0.65 

- 0.3 

- 1.3 

- 0.3 

- 0.03 

- 0.65 

- 0.3 

- 2. 

- 0.3 

- 2. 

- 0.65 

- 4. 

- 0.3 
-12. 

- 0.006 

- 1. 

- 2. 

- 2. 

- 0.3 

- 1.3 

- 2. 

- 8. 

- 2. 

- 8. 

- 0.25 

- 8. 

- 8. 

■ 4. 

- 2. 

■ 4. 

- 0.005 

- 1.3 
16. 

- 4. 

■ 2. 
• 4. 

■ 2. 

■ 8. 



14— M. M. 



210 



TABLE OF DOSES. 



Remedies. 



Syr. sennse 

Terebene 

Terpin hydrate (tanic expectorant) . . 

Thymol 

Tinct. aconiti . . 

aloes ... 

arnica? rad 

asafoetidse 

belladonnas 

cannabis ind 

capsici 

cimicifugae 

cinchonas comp 

colchici [sem.] 

conii 

digitalis 

ferri chloridi 

gelsemii 

guaiaci amnion 

hydrastis 

hyoscyami 

ignatise 

iodi comp 

kino 

lobelias 

moschi 

nucis vomicae 

opii 

opii camph 

physostigmatis 

stramon 

strophanthi (cardiant and diuretic) 

valer. ammon 

veratr. vir 

Tritu ratio elaterini (10 %) 

Urethane (hypnotic) 

Vin.antim.|^P e t ct ; etalt -; ; ; ; ; ; 

colch. rad. (40 %') - . . . 

colch. sem. (15 %) 

ergotse 

ferri amar 



inecac J ex P ect - 
ipecac. S emet# 



opii 

Zinci acet 

bromid 

iodid 

oxid 

phosphid. . . . 
sulphas (emet.) 
valerianas . . . 



Grains or 


Grams 


or Cubic 


Minims. 


Centimeters. 


t'51— f58 


4. 


-32. 


5— 15 


0.3 


- 1. 


2— 5 


0.13 


— 0.3 


1— 5 


0.06 


— 0.3 


i- 5 


0.03 


— 0.3 


15— 60 


1. 


— 4. 


5— 15 


0.3 


— 1. 


30— 60 


2. 


— 4. 


2— 15 


0.1 


— 1. 


5— 20 


0.3 


— 1.3 


8— 15 


0.5 


— 1. 


30— 60 


2. 


— 4. 


15—120 


1. 


— 8. 


. 5— 20 


0.3 


— 1.3 


5— 30 


0.3 


— 2. 


3— 15 


0.2 


— 1. 


10— 30 


0.6 


— 2. 


2— 15 


0.1 


— 1. 


30— 60 


2. 


— 4. 


30—120 


2. 


— 8. 


5— 30 


0.3 


— 2. 


5— 30 


0.3 


— 2. 


7— 15 


0.06 


— 1. 


15—120 


0.1 


— 8. 


5— 30 


0.3 


— 2. 


15— 60 


1. 


— 4. 


5— 15 


0.3 


— 1. 


2— 15 


0.1 


— 1. 


5—240 


0.3 


—16. 


5— 15 


0.3 


— 1. 


5— 15 


0.3 


- 1. 


2— 10 


0.1 


— 0.65 


10—120 


0.6 


— 8. 


3— 10 


0.2 


— 0.6 


4- i 


0.008 


- 0.06 


5— 30 


0.3 


— 2. 


1— 8 


0.06 


— 0.5 


30- 75 


2. 


— 5. 


5-15 


0.3 


— 1. 


5— 30 


0.3 


— 2. 


f51— f53 


4. 


—12. 


30— 60 


2. 


— 4. 


5— 15 


0.3 


— 1. 


f5 2— f56 


8. 


—24. 


5— 15 


0.3 


— 1. 


h~ 2 


0.03 


— 0.13 


h~ 5 


0.03 


— 0.3 


i- 3 


0.03 


— 0.2 


1— 5 


0.06 


— 0.3 


TTT — 5 


0.006 


— 0.01 


15— 30 


1. 


— 2. 


*- 5 


0.03 


— 0.3 



IMPORTANT POISONS AND THEIR ANTIDOTES. 



Acids, Hydrochloric, Nitric, Sulphuric. See Mineral Acids. 

Acid, Carbolic. Evacuation of stomach ; soluble sulphates, as the sulphates of mag- 
nesium, sodium, or dilute sulphuric acid. 

Acid, Hydrocyanic. Ammonia by inhalation and subcutaneously ; alcohol and 
atropine hypodermically ; artificial respiration. 

Acid, Oxalic. Lime salts (whitewash, chalk, etc.) ; calcii carbonas prsecipitatus ; 
syrupus calcis. 

Aconite. Evacuation of stomach ; recumbent position and perfect quiet ; diffusible 
stimulants {ammonia, alcohol) ; artificial respiration if necessary. 

iETHER. Artificial respiration; faradization of respiratory muscles; atropine and 
strychnine subcutaneously. 

Alcohol. Evacuation of stomach; aqua ammonise; heat. 

Alkalies, Caustic Pot ass a, and Soda. Weak acids, as acetic (vinegar), citric (lemon- 
juice) ; later demulcent drinks. 

Alkaloids. Tannic acid; iodide of potassium. 

Ammonia. Weak acids ; demulcents. 

Antimonii et Potassii Tartras. Tannic acid ; morphia ; free stimulation. 

Arsenic. Thorough evacuation of stomach ; Jerri oxidum hydratum, freshly prepared 
and frequently administered ; Jerri oxidum hydratum cum magnesia ; Jerrum dia- 
lysatum; stimulants. 

Atropine. Evacuation of stomach; respiratory and circulatory stimulants; mor- 
phine; physostigma. 

Belladonna. See Atropine. 

Cantharides. Opiates; demulcents in large quantities (water, flaxseed tea, etc.) y 
Avoid oils; alkaline diuretics. 

Chloral. As for Opium, q. v., but avoiding forced exertion; cardiac stimulants; 
heat. 

Chloroform. Inversion oj patient, head downward ; cardiac stimulants, alcohol, am- 
monia, and strophantus hypodermically ; amyl nitrite ; artificial respiration. 

Colchicum. Opium; stimulants ; demulcent drinks in later stages. 

Conium. Cardiac and respiratory stimulants ; artificial respiration ; external warmth 
and measures against shock in general. 

Copper Sulphate. Albumin ; sodii bicarb. 

Corrosive Sublimate. Albumin ; milk ; emetics. 

Croton Oil. Opium ; astringents ; demulcents. 

Digitalis. Quiet in recumbent position ; diffusible stimulants, as ammonia and 
alcohol. 

Gelsemium. Alcohol ; ammonia. 

Gas, Coal or Illuminating. Oxygen inhalations ; stimulants. 

Hyoscyamus. See Atropine. 

Ignatia. See Strychnine. 

Iodine. Starch; demulcents. 

Iodoform. Stimulants as indicated. 

211 



212 INCOMPATIBILITIES. 

Lobelia. Tannic acid ; stimulants ; opiates. 

Mineral Acids. Calcium and magnesium salts (chalk, aqua calcis, magnesia) ; al- 
kaline carbonates (soap) ; water and demulcent drinks. 

Muscarin (poison Mushrooms). Atropine; emetics if necessary. 

Nux Vomica. See Strychnine. 

Nitrate of Silver. Common salt (sodium chloride). 

Opium and its Alkaloids. Evacuation of stomach by stomach-pump or emetics— by 
the latter preferably mustard, cupri sulphas, or zinci sulphas ; tannic acid ; strych- 
nine ; atropine tentatively, guided by respiratory effects ; caffeine ; black coffee ; 
various methods of respiratory stimulation ; oxygen inhalations ; cardiac stim- 
ulants. 

Oleum Amygdalae Amar,e. See Hydrocyanic Acid. 
Physostigma. Atropine ; heat ; artificial respiration. 

Phosphorus. Sulphate of copper as emetic and antidote ; old French oil of turpentine. 
Potassii Chloras and Potassii Nitras. Emetics; cathartics; opium; demulcents. 
Potassa, Caustic See Alkalies. 
Prussic Acid. See Hydrocyanic Acid. 
Potassii Cyanidum. See Hydrocyanic Acid. 
Stramonium. See Atropine. 

Strychnine. Chloroform or sether, if necessary to check convulsions ; chloral ; bromides. 
Soda, Caustic. See Alkalies. 

Tartar Emetic. See Antimonii et Potassii Tartras. 

Veratrum Viride. Emetics if drug have not been self-emetic ; recumbent posture 
and enforced quiet ; heat ; diffusible stimulants subcutaneously and per rectum. 
Zinc, Chloride or Sulphate. Albumin ; sodium bicarbonate. 



INCOMPATIBILITIES. 



Drugs may be physiologically or chemically incompatible with each other. Physio- 
logical incompatibility will be understood only by a thorough knowledge of their 
physiological effects, chemical incompatibility by strict attention to chemical prin- 
ciples. 

When possible make use of the greatest simplicity in prescribing, avoiding multi- 
plicity of drugs in the same prescription. Scientific interest will thus be subserved, 
a clea'rer insight into the effects of individual drugs will be possible, and at the same 
time all likelihood of the ingredients neutralizing each other or forming unpleasant 
or dangerous compounds avoided. 

Remember the chemical principle that soluble salts brought together in the same 
solution generally, if possible, exchange radicals, with a resultant insoluble com- 
pound or precipitate. Hence such combinations are to be avoided ; also, that the 
stronger mineral acids decompose salts of the weaker mineral and vegetable acids, 
and form ethers with alcoholic preparations. These general statements simply serve 
to illustrate the bearing of chemistry on the subject of incompatibles. A complete 
list of incompatible combinations would be inappropriate in a work of this kind. 
Following are a few general statements, involving the most important ones : 

Alkalies are incompatible with acid solutions, alkaloids, and the soluble non-alka- 
line metallic salts. 

Alkaloids in general with tannic acid, alkalies, and chlorinous compounds. 

Stronger mineral acids with alkalies and salts of relatively weak acids (carbonic, 
hydrobromic, hydriodic, acetic, citric, etc.). 



CLASSIFICATION OF DRUGS. 213 

Arsenic with tannic acid, salts of iron (especially hydrate), and lime and magnesia. 
In fact, as a matter of course, all drugs with their antidotes. 

Carbonates with stronger acids and acid salts. 

Chlorides with salts of silver and lead, and with alkalies. 

Corrosive Sublimate with almost everything : it is best given alone in simple syrup, 
even the compound syrup of sarsaparilla being said to slightly decompose it ; it is, 
however, often administered in combination with potassium iodide, which it decom- 
poses, with the formation of an efficient double salt. 

Digitalis with iron and preparations containing tannic acid. 

Glucosides with free acids and substances containing emulsin. 

Iodine and Iodides with alkaloids and the ordinary soluble metallic salts. Iodine 
and potassium iodide are compatible, as in Lugol's solution. 

Iron salts with tannic acid and astringents. 

Mucilages with acids, iron salts, and alcohol. 

Syrup of Squill contains acetic acid, and is incompatible with the carbonate of am- 
monium, but not with the chloride. 

Sweet Spirit of Nitre with sulphate of iron, tincture of guaiac, and carbonates. 

Tannic and Gallic acids and the vegetable astringents with alkaloids and salts of 
iron and lead. Vegetable infusions in general with metallic salts. Tannic acid pre- 
cipitates albumin and gelatin. 

Nitrate of Silver and the acetate and subacetate of lead are best prescribed alone. The 
first may be administered with opium and extract of hyoscyamus. The lead salts 
are much used with opium in " lead-and-opium wash," the insoluble resultant being 
therapeutically efficient. 

Water with tinctures and other alcoholic preparations containing resin (as spirit of 
camphor): the resin is precipitated. When such combinations are necessary, add 
acacia or other emulsifying agent. 

Powerful oxidizing agents with easily oxidizable substances : combustion, and even 
explosion, may occur. Among the oxidizing agents in general medicinal use may 
be mentioned potassium chlorate, potassium permanganate, chromic, nitric, and 
nitro-hydrochloric acids. Especially combustible are glycerin, sugar, alcohol, fats, 
sulphur, and phosphorus. 



CLASSIFICATION OF DRUGS 

ACCORDING TO THEIR ACTION. 



Antispasmodics. Camphor, spiritus setheris compositus, valerian, asafcetida, mos- 
chus, succinum, humulus. 

Anaesthetics. iEther, chloroform, nitrogen monoxide, ethylene bichloride, ethyl 
bromide. 

Local Anesthetic. Cocaine. 

Hypnotics or Somnifacients. Opium, cannabis Indica, cannabis Americana, chloral, 
chloralamid, potassium bromide, sodium bromide, lithium bromide, hydrobromic 
acid, sulphonal, amylene hydrate, paraldehyde, urethane. 

Belladonna Group. Belladonna, stramonium, hyoscyamus, duboisia. 

Spinants— Excito-motws. Nux vomica, ignatia, cocculus indicus [ergot, digitalis].— 
Depresso-motors. Physostigma, curare, conium, gelsemium, lobelia, tabacum. 

Affecting Circulatory System.— Cardiants. Ammonia, alcohol, digitalis, strophan- 
tus, convallaria, sparteine, adonidine, caffeine.— Nitrite Group. Amyl nitrite, 
nitro-glycerin, potassium nitrite, sodium nitrite.— Cardiac Depressants. Antimony, 
veratrum viride, veratrine, aconite, Pulsatilla, arnica, staphisagria, hydrocyanic 



214 CLASSIFICATION OF DRUGS. 

acid, potassium cyanide, bitter oil of almonds, vegetable acids— acetic, citric, 
tartaric. 

Astringents. — Vegetable Astringents. Tannic acid, gallic acid, galls, krameria, cate- 
chu, kino, hsematoxylon, hamamelis, quercus alba, rosa gallica, rubus, castanea, 
rhus glabra, etc. — Mineral Astringents. Silver, copper, zinc, lead, alum. 

Tonics.— Iron and its salts, manganese, sulphuric acid, hydrochloric acid,nitric acid, 
nitro-muriatic acid, lactic acid, phosphorus. 

Alteratives. Arsenious acid, mercury, iodine and the iodides, iodoform, iodoi, cod- 
liver oil, phosphoric acid, hypophosphites, sarsaparilla, guaiac, mezereum, sas- 
safras, taraxacum, ichthyol, colchicum. 

Antiperiodics. Cinchona and its alkaloids, eucalyptus, Warburg's tincture. 

Antipyretics. Salicylic acid and the salicylates, salicin, oil of gaultheria, salol, 

betol, carbolic acid, creosote, kreolin, thymol, resorcin, benzoin and benzoic 

acid, antipyrin, antifebrin, phenacetin, thallin, kairin, naphthaline. 
Stomachic Bitters.— Simple. Quassia, gentian, calumba, chirata, hydrastis — Aro- 

matics. Serpen taria, cascarilla, anthemis, eupatorium, cimicifuga, absinthe. — 

Astringents. Cornus, prunus Virginiana. 

Diuretics. Squill, scoparius, apocynum, triticum, vascular diuretics (see Cardiants), 
potassium compounds. 

Blennorrhetics. Buchu, pareira, matico, uva ursi, juniper, chimaphila, oil of erig- 
eron, oil of turpentine, copaiba, cubeb. 

Cathartics. — Laxatives. Tamarind, manna, cassia fistula, castor oil, olive oil, mag- 
nesia.— Salines. Magnesium sulphate, solution of magnesium citrate, Rochelle 
salt, phosphate of soda, sulphate of potassa, bitartrate of potassium.— Astringent 
Resin-bearing Purgatives. Rhubarb, senna, aloe, cascara sagrada, frangula, jug- 
lans, leptandra — Drastics. Jalap, podophyllum, chelidonium, iris, euonymus, 
scammony, colocynth, camboge, elaterium, croton oil.— Mercurials. Calomel, 
massa hydrargyri. 

Anthelmintics. Santonica, spigelia, chenopodium, azedarach, aspidium, granatum, 
kamala, brayera, pumpkin, oil of turpentine, ailanthus. 

Emetics.— A. Local : Mineral. Copper sulphate, zinc sulphate, alum, turpeth mineral. 
— Vegetable. Mustard— B. Systemic: Ipecac, apomorphine, sanguinaria, tartar 
emetic. 

Diaphoretics. Pilocarpus, liquor ammonii acetatis, sweet spirit of nitre, antimony, 
ipecac, refrigerant diaphoretics. 

Expectorants. Lobelia, antimonv, ipecac, grindelia, Pulsatilla, senega, ammonium 
chloride, garlic, balsam of Peru, balsam of Tolu, pix liquida, terebene, terpin 
hydrate. 

Emmenagogues — Tonic Emmenagogues. Iron, manganese.— Purgative Emmenagogues. 
Aloe.— Stimulating Emmenagogues. Savine, rue, parsley, tansy, water-pepper. 

Oxytocics. Ergot, cotton-root bark, ustilago, cimicifuga. 

Irritants.— (1) Rubefacients. Mustard, capsicum, Burgundy pitch, Canada pitch, oil 
of turpentine.— (2) Vesicants. Cantharides, stronger ammonia.— (3) Escharotics. 
Nitrate of silver, caustic potassa, caustic soda, arsenious acid, zinc chloride, bro- 
mine, chromic acid, solution of nitrate of mercury, nitric acid.— (4) Suppurants. 
Croton oil, ointment of antimony.— (5) Mild Irritants. Green soap, chrysarobin. 

Demulcents. Water, acacia, tragacanth, cetraria, chondrus, ulmus, licorice, lyco- 
podium, starch, althaea, cydonium, sassafras medulla. 

Emollients. Lanolin, glycerin, petrolatum, lard, oil of theobroma, cetaceum, white 
and yellow wax. 

Protectives. Pyroxylum, collodion, gutta percha, etc. - 

Antacids. Sodium and its salts, lime and lime salts. 

Antiseptics. Lime, ozone, peroxide of hydrogen, permanganate of potassium, sul- 
phurous acid, corrosive sublimate, boric acid, borax, chlorine-water, chlorinated 
lime, solution of chlorinated lime. 

Aromatics. Cinnamon, cloves, nutmeg, allspice, cardamom, ginger, pepper, cap- 
sicum. 



INDEX. 



A. 

Absinthium, 133 
Acacia, 182 
Acetate of lead, 90 
Acetic acid, 79 
glacial, 181 
Acid, phosphoric, dil., 108 
Acids, vegetable, 79 
Acidiini arseniosum, 179 

carbolicuni. See Carbolic Acid, 119 
physiological effects, 120 
preparations, 121 
therapeutics, 121 
toxicology, 120 

chromicum, 180 

hydrocyanicum, 77 

nitricuni, 180 

salicylicum, 116 
Aconite, 74 

physiological effects, 75 

therapeutics, 75 

toxicology, 75 
Adeps, 186 

Administration of drugs, 19 
Adonidin, 70 
.Ether, 27 
Agaricin, 47 
Ailanthus, 156 
Alcohol, 61, 163 

administration, 64 

alcoholism, 64 

habitual use of, 63 

physiological effects, 62 

preparations, 65 

properties, 62 

therapeutics, 64 
Alcoholic potassa, 178 
Alimentation in disease of alimentary 

tract, 203 
Allium, 166 
Allspice, 194 

M. M. 



Aloes, 149, 168 
Alteratives, 99 
Althaea, 185 
Alum, 91, 157 
Alumen, 91 
Amber, 26 
Ammonia, 60 

physiological effects, 60 

preparations, 60 

therapeutics, 61 

toxicology, 61 
Ammonium bromide, 40 

chloride, 165 

effects and uses, 166 
Amyl nitrite, 57 

physiological effects, 58 

therapeutics, 58 
Amylene hydrate, 41 
Amylum, 184 
Anaesthesia, 29 

how to produce, 29 

local, 30 
Anaesthetics, definition, 27 
Antacids, 188 

magnesium salts, 189 

potassium salts, 189 

sodium salts, 188 
bicarbonate, 188 
carbonate, 188 
Anthelmintics, 154 
Anthemis, 131 
Antifebrin, 126 

therapeutics, 127 
Antimony, 72 

physiological effects, 72 

preparations, 72 

therapeutics, 72 

toxicology, 72 
Antiperiodics, 111 
Antipyrin, 125 

how prescribed, 126 

therapeutics, 126 



215 



216 



INDEX. 



Antiseptics, 190 
Antispasmodics, definition, 23 
Apocynum, 135 
Apomorphine, 159 
Aqua, 182 

ammon. fortior, 177 
Argentum, 85 
Argent, nitrat. fusus, 178 
Argyria, 86 
Aristol, 107 
Arnica, 76 

Aromatic bitters, 131 
Aromatics, 193 
Arsenic, 99, 179 

administration, 101 

effects, 100 

preparations, 99 

therapeutics. 101 

toxicology, 100 
Arsenious acid, 99 
Asafoetida, 25 
Aspidium, 155 
Astringent bitters, 133 
Astringents, 80 
Aurantii amari cortex, 194 

dulcis cortex, 194 
Azedarach, 155 



Balsam of Peru, 166 

of Tolu, 167 
Baths, Bussian, 18 

Turkish, 18 
Bearberrv, 140 
Beef, 200 
Belladonna, 43 

physiological effects, 43, 44 

preparations, 43 

therapeutics, 44 

toxicology, 45 
Benzoate of lithium, 125 

of sodium, 125 
Benzoin, 124 
Betol, 119 

Bichloride of mercury, 191 
Bitter orange-peel, 194 
Black cohosh, 173 

mustard, 157, 174 

snake-root, 132, 173 
Blennorrhetics, 139 
Blood-root, 159 

effects, 160 

preparations, 160 



Blood-root, uses, 160 
Blue flag, 151 

mass, 153 

vitriol, 157 
Boneset, 132 
Borax, 192 
Boric acid, 192 
Bray era, 156 
Bromide of ammonium, 40 

of potassium, 39 

of sodium, 40 
Bromine, 179 

effects and uses, 180 
Bromism, 39 
Bromum, 179 

effects and uses, 176 
Broom, 135 
Brucine, 51 
Buchu, 139 
Burgundy pitch, 175 
Butter, 197 
Buttermilk, 198 
Butternut, 150 



c. 



Cacao butter, 186 
Caffeine, 70 

physiological effects, 71 

preparations, 71 

therapeutics, 71 

toxicology, 71 
Calabar bean, 52 
Calcium phosphate, 108 

salts of, 189 
Calisaya bark, 111 
Calomel, 153 
Calumba, 129 
Calx, 188, 190 

chlorata, 193 
Cambogia, 152 
Camphor, 23 

physiological action of, 23 

preparations of, 23 

therapeutics of, 24 
Canada pitch, 176 
Canadian hemp, 135 
Cannabis Americana, 36 

Indica, 36 
Cantharides, 176 

effects, 177 

preparations, 176, 17/ 

therapeutics, 177 

toxicology, 177 



INDEX, 



217 



Capsicum, 175, 194 
Carbolic acid, 119 
Cardamom, 194 
Cardiac depressants, 72 

stimulants, 59 
Carrageen, 183 
Carthagena bark, 111 
Caryophyllus, 194 
Cascara sagrada, 149 
Cascarilla, 132 
Cassia fistula, 146 
Castor oil, 145 
Catechu, 83 
Cathartics, 144 
Caustic potash, 178 

soda, 179 
Caustics, 178 
Cauterants, 178 
Cayenne pepper, 175 
Cera alba, 187 

flava, 187 
Cetaceum, 186 
Cetraria, 183 
Chamomile, 131 
Cheese, 198 
Chelidonium, 151 
Chenopodium, 155 
Chicken, 200 
Children, dosage for, 19 
Chimaphila, 141 
Chinoidin, 115 
Chirata, 130 
Chloral, 36 
hydrate, 36 
dosage, 38 

physiological effects, 3* 
therapeutics, 37 
toxicology, 37 
acute, 37 
chronic, 37 
Chloralamid, 38 
Chloride of zinc, 179 
Chlorinated lime, 193 
Chlorine-water, 192 
Chloroform, 28 

contraindications for, 29 
indications for, 29 
physiological eifects, 28 
preparations, 28, 29 
toxicology, 29 
treatment of, 30 
Chondrus, 183 
Chromic acid, 180 
Chrvsarobin, 181 



Chrysarobinum, 181 
Cimicifuga, 132, 173 
Cinchona, 111 

constituents, 111 

incompatibilities, 112 

physiological effects, 112 

preparations, 111, 112 

varieties of bark, 111 
Cinchonicine, 111 
Ciuchonidine, 111, 112 

effects, 114 

uses, 114 
Cinchonine, 111, 112 

effects, 114 

uses, 114 
Cincho-tannic acid, 111 
Cinnamomum, 193 
Citric acid, 79 
Cloves, 194 
Cocaine, 30, 48 
Cocculus Indicus, 51 
Cocoanut, 156 
Codeine, 34 
Cod-liver oil, 107 
Colchicum, 110 
Cold, 18 
Collodion, 187 
Colocynthis, 152 
Columbian bark, 111 
Columbo, 129 

Compound syrup of squill, 157 
Conium, 54 
Convallaria, 69 
Copaiba, 143 
Copper, 86 

antidotes, 87 

physiological effects, 87 

sulphate, 157 

therapeutics, 87 
Corn ergot, 172 
Cornmeal, 201 
Cornus, 133 

Corrosive sublimate, 191 
Couch-grass, 136 
Cream, 197 

of tartar, 138 
Creasote, 122 
Creolin, 122 
Croton chloral, 38 

oil, 153, 181 
Cubeb, 143 

physiological effects, 144 

preparations, 144 

uses, 144 



218 



INDEX. 



Cubeba, 143 
Culver's physic, 150 
Cuprum, 86 
Curare, 53 
Cydonium, 185 
Cymylic acid, 123 

D. 

Demulcents, 182 
Depressomotors, 52 
Diaphoretics, 160 
Diet, animal, 202 
dry, 202 
for fever, 202 
low, 202 i 
plans of, 202 
Dietetics, 195 

classification, 195 
Digestive ferments, 203 
Digitalis, 65 

administration, 6? 
contraindication, 67 
physiological effects, 66 
preparations, 66 
therapeutics, 67 
toxicology, 68 
Dioxide of hydrogen, 191 
Disinfectants, 190 
Diuretics, 134 
Dosage for children, 19 
Cowling's rule, 19 
Young's rule, 19 
Drugs, methods of administration, 19 
Duboisia, 47 

E. 

Eggs, 199 
Elaterinum, 152 
Electricity, 19 
Elm, slippery, 183 
Emetics, 157 

indications, 157 

purposes, 157 
Emmenagogues, 168 
Emollients, 185 
Emplastrum pic. Canaden., 176 

plumbii, 187 

resinse, 187 

saponis, 187 
Epsom salts, 146 

Equivalents, troy and metric systems, 
22 



Ergot, 170 

physiological effects, 171 

preparations, 171 

uses, 172 
Ergota, 170 
Ergotism, 171 
Erythroxylon coca, 48 
Escharotics, 178 
Ether, 27 

contraindications for, 29 

hydrobromic, 30 

indications for, 29 

internal use, 28 

physiological effects, 27 

preparations, 28 

toxicology, 30 
treatment of, 30 
Ethyl bromide, 30 
Ethylene bichloride, 30 
Eucalyptus, 115 
Euonymus, 151 
Eupatorium, 132 
Excito-motors, 49 
Expectorants, 163 

F. 

Farinaeeous food-stuffs, 201 
Ferments, digestive, 203 
Ferrum, 91, 168 
Fish, 201 
Flaxseed, 184 
Frangula, 150 

G. 

Galla, 82 
Gallic acid, 81 
Gamboge, 152 
Garlic, 166 
Gelsemium, 55 

toxicology, 56 
Gentian, 129 
Geranium, 84 
German chamomile, 131 
Germicides, 190 
Ginger, 194 
Glauber's salts, 147 
Glonoin, 59 
Glycerin, 185 
Glycyrrhiza, 184 
Gossypii rad. cortex, 172 
Granatum, 156 
Green soap, 181 



INDEX. 



219 



Grindelia, 164 

uses, 165 
Guaiac, 109 

preparations, 175 
Gum Arabic, 182 
Gun-cotton, 187 
Gutta-percha, 187 

H. 

Hseniatoxylon, 83 
Haroanielis, 84 
Heat, 17 
Hemlock, 54 
Hemp, 36 

American, 36 

Indian, 36 
Hoffman's anodyne, 24 
Homatropine hydrobromate, 45 
Hops, 26 
Humulus, 26 
Hydragogues, 150 
Hydrargyri chlorid. corros., 191 
Hydrargyrum, 101, 180 

caustic uses, 180 
Hydrastis, 130 
Hydrobromic acid, dilute, 41 

ether, 30 
Hydrochloric acid, 95, 181 

effects and uses, 96 
Hydrocyanic acid, 77 

administration, 78 

therapeutics, 78 

toxicology, 78 
Hydrogen dioxide, 191 

peroxide, 191 
Hyoscyamus, 46 

physiological effects, 47 

toxicology, 47 
Hypnone, 42 
Hypnotics, 31 
Hypophosphites, 108 



Iceland moss, 183 

Ichthyol, 109 

Ignatia, 51 

Indian hemp, 135 

Iodide of potassium. 
Iodide, 104 

Iodine, 103 
absorption, 104 
elimination, 104 



See Potassium 



Iodine, physiological effects, 104 

therapeutics, 104 

toxicology, 104 
Iodoform, 106 
Iodoformum, 106 
Iodol, 106 
Iodolum, 106 
Iodum. See Iodine, 103 
Ipecac, 158, 163, 164 

administration, 159 
Ipecacuanha, 158 
Iris, 151 
Irish moss, 183 
Iron, 91, 168 

physiological effects, 92 • 

preparations, 92, 93 

therapeutics, 92 
Irritants, 173, 181 

contraindications, 174 

indications for, 173 

J. 

Jaborandi, 161 

administration, 162 

uses, 162 
Jalap, 150 
Juglans, 150 
Juniper, 140 



K. 



Kairin, 128 
Kamala, 156 
Kinic acid. Ill 
Kino, 83 

Kinovic acid, 111 
Koumyss, 198 
Kousso, 156 
Krameria, 83 
Kreolin, 122 



Lactic acid, 97 
Lanoline, 185 
Lard, 186 
Laughing gas, 30 
Laxatives, 145 
Lead, 89 

acetate, 90 
Leptandra, 150 
Licorice, 184 



220 



INDEX. 



Light, 17 
Lime, 188, 190 

water, 189 
Linum, 184 
Liquor ammonium aeetatum, 162 

calcis, 189 

Magendie, 32 

magnesium citrate, 146 

morphinum sulphate, 33 
Lithium benzoate, 125 
Lobelia, 56, 164 
London paste, 179 
Lycopodium, 184 

M. 

Mace, 194 

Macis, 194 

" Magendie's solution," 32 

Magnesia, 145 

Magnesii citras granulatus, 146 

Magnesium sulphate, 146 

Magnolia, 133 

Male fern, 155 

Mandrake, 150 

Manganese, 94, 168 

Manna, 145 

Matico, 140 

Matricaria, 131 

Matzoon, 198 

Mercurial cathartics, 153 

Mercuric chloride, 191 

Mercury, 101 

physiological effects, 102 

preparations, 102 

therapeutics, 103 
Methylal, 42 

salicylate, 118 
Methylene bichloride, 30 
Mezereon, 109 
Milk, 195 

diseases caused by, 196 

indications for, 196 

modifications of, 196 

unpleasant effects of, 197 
Morphine. See Opium, 34 
Moschus, 26 
Mother's milk, 195 

substitutes for, 195 
Musk, 26 
Mutton, 200 
Myristica, 194 
My rosin, 174 
Myrrh, 168 



Naphthaline, 128 
Naphthalol, 119 
Nitre, 138 
Nitric acid, 96, 180 
Nitrite of amyl, 57 

of potassium. 59 

of sodium, 59 
Nitrogen monoxide, 30 
Nitro-glycerin, 59 
Nitro-hydrochloric acid, 96 
Nutmeg, 194 

effects and uses, 97 
Nux vomica, 49 

preparations, 49 

o. 

Oatmeal, 201 

Oil of fleabane, 141 

of juniper, 140 

of sandalwood, 144 

of thyme, 123 

of turpentine, 141 

of wintergreen. See Oleum Gmilthe- 
rise, 118 
Oleum ainygdalse, 146 

cinnamomi, 193 

erigeron, 141 

gaultherise, 118 

lini, 146 

morrhuse, 107 

olivse, 146 

ricini, 145 

santali, 144 

sassafras, 194 

terebinthinse, 156 

theobromal, 186 

tiglii, 153, 181 
Opium, 31 

administration, 35 

alkaloids, 34 

physiological effects, 33 

poisoning, acute, 34 
chronic, 35 

preparations, 32 

therapeutics, 35 
Oxalic acifl, 80 
Oxytocics, 170 
Ozone, 190 



P. 



Pancreatine, 204 



INDEX. 221 


Paraldehyde, 42 


Potassium iodide, 104 


Pareira, 139 


administration, 105 


Parsley, 169 


comparison with other iodides, 105 


Pepo, 156 


physiological effects, 105 


Pepsin, 203 


preparations, 105 


uses of, 204 


nitrite, 59, 138 


Peptonized milk, 199 


salts, 136 


Permanganate of potassium, 191 


physiological effects, 136 


Peroxide of hydrogen, 191 


sulphate, 147 


Petrolatum, 186 


Potato, 201 


Petroselinum, 169 


Preparations of drugs, different forms 


Phenacetin, 127 


of, 20 


Phenic acid, 119 


Protectives, 187 


Phenol, 119-123 


Prunus Virginiana, 133 


Phenyl alcohol, 119 


Pulsatilla, 76, 165 


hydrate, 119 


Pulvis glycyrrhizse comp., 146 


Phosphoric acid, 108 


Pumpkin, 156 


Phosphorus, 97 


Putrefaction, 190 


administration, 99 


necessary conditions for, 190 


effects, 98 


Pyroxylinum, 187 


therapeutics, 99 




toxicology, 98 




Physostigma, 52 


Q. 


alkaloids, 52 




physiological effects, 52 
preparations, 52 
therapeutics, 53 
toxicology, 53 
Picrotoxin, 51 


Quassia, 129 
Quercus alba, 84 
Quinicine, 111 
Quinidine, 111, 112 
effects, 114 


Pilocarpus, 161 


properties, 114 


Pimenta, 194 
Piper, 194 

Pix Burgundica, 175 
Canadensis, 176 


uses, 114 
Quinine, 111 
absorption, 113 
administration, 114 


liquida, 167 
Podophyllum, 150 
effects and uses, 151 


contraindications, 114 
elimination, 113 
preparations, 112 


preparations, 151 
Polygonum hydropiperoides, 170 
Pomegranate, 156 


properties, 112 
therapeutics, 113 
Quinoidin, 115 


Pork, 200 




Potassa, 178 


R. 


cum calce, 178 


JLU* 


with lime, 178 


Eefrigerant diuretics, 136 


Potassii permanganas, 191 


Resorcin, 123 


Potassium acetate, 137 


Rheum, 147 


bicarbonate, 137 


Rhubarb, 147 


bitartrate, 138, 147 


physiological effects, 148 


bromide, 39 


preparations, 147, 148 


administration, 40 


therapeutics, 148 


therapeutics, 40 


Rochelle salts, 146 


carbonate, 137 


Rubefacients, 174 


chlorate, 138 


Rue, 169 


cyanide, 79 


Ruta, 169 



222 



INDEX. 



s. 

Sabina, 169 
Saccharin, 186 
Salicin, 117 
Salicinum, 117 
Salicylic acid, 116 

therapeutics, 117 
Salines, 146 
Salix, 133 
Salol, 118 

how prescribed, 119 

therapeutics, 118 
Saltpetre, 138 
Sanguinaria, 159 
Santonica, 154 

effects, 155 
Sapo viridis, 181 
Sarsaparilla, 108 
Sassafras, 109, 185 
Savine, 169 
Scanimonium, 151 
Scammony, 151 
Scilla, 134 
Scoparius, 135 
Senega, 165 
Senna, 148 
Serpentaria, 131 
Silver, 85 

therapeutics, 86 
Simple bitters, 129 
Sinapis, 174 

effects and uses, 175 
Skimmed milk, 197 
Slippery elm, 183 
Smartweed, 170 
Sodii sulpho-carbolas, 121 
Sodium benzoate, 125 

bromide, 40 

nitrite, 59 

phosphate, 147 

sulphate, 147 
Soft soap, 181 
Somnifacients, 31 
Spanish fly, 176 
Sparteine, 70 
Spermaceti, 186 
Spigelia, 155 
Spinants, 48 

Spirits of turpentine, 141 
Spiritus setheris comp., 24 
nitrosi, 162 

Mindcreri, 162 
Squill, 134 s 



i Squill, toxicology, 135 

uses, 135 
! Staphisagria, 77 
; Starch, 184 
Stomachic bitters, 128 
i Stramonium, 46 
! Strophanthus, 68 
Strychnine, 49 
administration, 51 
physiological effects, 49 
therapeutics, 50 
toxicology, 50 
Succinum, 26 
Sulphate of copper, 157 
Sulpho-carbolate of sodium, 121 
Sulphonal, 41 
Sulphur, 145 
Sulphuric acid, 94, 181 
effects, 95 
therapeutics, 95 
toxicology, 95 
J Sulphurous acid, 191 
Suppurants, 181 
Sweet orange-peel, 194 

spirit of nitre, 162 
Syrupus calcis, 189 

T. 

Tabacum, 57 
Tamarindus, 145 
Tanacetum, 170 
Tannic acid, 80 
Tansy, 170 
Tar 167 

Tartar emetic, 160, 163, 164 
Tartaric acid, 79 
Terebene, 167 
Terebinth in a, 141 
Terpin hydrate, 168 
Thallin, 127 
Thermometer, 17 

Centigrade, 18 

Fahrenheit, 18 
Thiersch's solution, 192 
Thorough wort, 132 
Thymic acid, 123 
Thymol, 123 
Tobacco, 57 
Tonics, 91 
Tragacanth, 183 
Triticum, 136 
Turpentine, 141 

therapeutics, 142 



INDEX. 



223 



Turpeth mineral, 157 

u. 

Ulmus, 183 

Ung. antimonii, 181 

" United States solution " of morphine, 

33 
Urethan, 42 
Ustilago, 172 
Uva ursi, 140 

V. 

Valerian, 24 
Vascular diuretics, 136 
Veal, 200 

Vegetable acids, 79 
Vegetables, 201 
Veratrina, 74 
Veratroidine, 73 
Veratrum viride, 73 

administration, 74 

physiological effects, 73 

preparations, 73 

therapeutics, 73 

toxicology, 74 
Vermicides, 154 
Vermifuges, 154 
Vesicants, 176 
Virginia snake-root, 131 



Viscera used as food, 201 



W. 

Wahoo, 151 

Warburg's tincture, 115 

Water, 182 

pepper, 170 
Weights and Measures, tables of, 22 
Wheat, 201 
White mustard, 157, 174 

vitriol, 157 

wax, 187 
Wild cherry, 133 
Woorara, 53 



Yellow wax, 187 



Z. 

Zinc, 87 

antidotes, 88 

chloride, 179 

physiological effects, 88 

sulphate, 157 

therapeutics, 87 
Zingiber, 194 

preparations of, 194 



